Active NPI
Michelle Whitaker, LAT, PES
- Athletic Trainer
- Sussex, WI
National Provider Identifier
1770503039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 481-039
- Practice address
- N63W23075 Main St
Sussex, WI 53089-5303 - Phone
- (414) 566-4583
- Fax
- (414) 566-4640
- NPI assigned
- Jul 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 481-039 | WI | Primary |
Addresses
Primary practice location
N63W23075 Main St
Sussex, WI 53089-5303
Mailing address
711 W Monrovia Ave
Glendale, WI 53217-4432
Phone (414) 566-4583
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 |
|---|---|---|---|
| 481-039 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770503039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 W MONROVIA AVE",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532174432",
"telephone_number": "414-566-4583",
"fax_number": "414-566-4640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N63W23075 MAIN ST",
"city": "SUSSEX",
"state": "WI",
"postal_code": "530895303",
"telephone_number": "414-566-4583",
"fax_number": "414-566-4640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITAKER",
"first_name": "MICHELLE",
"name_prefix": "Mrs.",
"credential": "LAT, PES",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "481-039",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sussex, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.