Active NPI
Jackie Wiedemann
- Family Nurse Practitioner
- Arcata, CA
National Provider Identifier
1780731778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 333007
- Practice address
- 1 Harpst St
Arcata, CA 95521-8222 - Phone
- (707) 826-3146
- NPI assigned
- Jan 4, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 333007 | CA | Primary |
Addresses
Primary practice location
1 Harpst St
Arcata, CA 95521-8222
Mailing address
1 Harpst St
Arcata, CA 95521-8222
Phone (707) 826-3146
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 333007 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| California State Polytechnic University, Humboldt | Past | Accepting new patients | |
| Humboldt State University | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Student Health Clinic/Center
- Arcata, CA
- NPI 1104991744
-
- Student Health Clinic/Center
- Arcata, CA
- NPI 1659793602
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780731778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 HARPST ST",
"city": "ARCATA",
"state": "CA",
"postal_code": "955218222",
"telephone_number": "707-826-3146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 HARPST ST",
"city": "ARCATA",
"state": "CA",
"postal_code": "955218222",
"telephone_number": "707-826-3146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEDEMANN",
"first_name": "JACKIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "333007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arcata, CA
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.