Active NPI
Samantha A Metko, RDN, IBCLC
- Registered Dietitian
- New London, WI
National Provider Identifier
1750948394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 661-29
- Practice address
- N3075 Bean City Rd
New London, WI 54961-8912 - Phone
- (920) 540-0094
- NPI assigned
- May 20, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Lactation Consultant (Non-RN) | 174N00000X | L-22761 | ||
| Registered Dietitian | 133V00000X | 661-29 | WI | Primary |
Addresses
Primary practice location
N3075 Bean City Rd
New London, WI 54961-8912
Mailing address
N3075 Bean City Rd
New London, WI 54961-8912
Phone (920) 540-0094
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 661-29 | Other | WI | STATE OF WISCONSIN: DEPARTMENT OF SAFETY PROFESSIONAL SERVICES |
| L-22761 | Other | IBCLC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 661-29 | WI | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568073600000",
"number": "1750948394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N3075 BEAN CITY RD",
"city": "NEW LONDON",
"state": "WI",
"postal_code": "549618912",
"telephone_number": "920-540-0094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N3075 BEAN CITY RD",
"city": "NEW LONDON",
"state": "WI",
"postal_code": "549618912",
"telephone_number": "920-540-0094"
}
],
"practiceLocations": [],
"basic": {
"last_name": "METKO",
"first_name": "SAMANTHA",
"middle_name": "A",
"credential": "RDN, IBCLC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-20",
"last_updated": "2019-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "174N00000X",
"taxonomy_group": "",
"desc": "Lactation Consultant, Non-RN",
"state": null,
"license": "L-22761",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WI",
"license": "661-29",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF WISCONSIN: DEPARTMENT OF SAFETY PROFESSIONAL SERVICES",
"identifier": "661-29",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IBCLC",
"identifier": "L-22761",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in New London, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.