Active NPI
Michelle Manke
- Adult Health Nurse Practitioner
- Appleton, WI
National Provider Identifier
1790069599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 147545-30
- Practice address
- N9168 Cherry Meadow Dr
Appleton, WI 54915-4681 - Phone
- (920) 284-5784
- NPI assigned
- Sep 28, 2011
- 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 147545-30 | WI | Primary |
Addresses
Primary practice location
N9168 Cherry Meadow Dr
Appleton, WI 54915-4681
Mailing address
9900 Bren Rd E
Mail Route MN 008-B213
Minnetonka, MN 55343-9664
Phone (920) 574-1255
Other practice location 1
491 S Washburn St
Oshkosh, WI 54904-6733
Phone (920) 749-1171
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790069599 | Medicaid | WI |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 147545-30 | WI | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596412800000",
"number": "1790069599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9900 BREN RD E",
"address_2": "MAIL ROUTE MN 008-B213",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553439664",
"telephone_number": "920-574-1255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N9168 CHERRY MEADOW DR",
"city": "APPLETON",
"state": "WI",
"postal_code": "549154681",
"telephone_number": "920-284-5784"
}
],
"practiceLocations": [
{
"address_1": "491 S Washburn St",
"address_purpose": "LOCATION",
"city": "Oshkosh",
"state": "WI",
"postal_code": "549046733",
"country_code": "US",
"telephone_number": "920-749-1171",
"fax_number": "920-749-1172",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MANKE",
"first_name": "MICHELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-28",
"last_updated": "2020-08-03",
"certification_date": "2020-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "WI",
"license": "147545-30",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1790069599",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.