Active NPI
Debra Lynn Tidquist, APRN-BC
- Family Nurse Practitioner
- Whitehall, WI
National Provider Identifier
1841398765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 2950-33
- Practice address
- 18601 Lincoln St
Whitehall, WI 54773-8605 - Phone
- (715) 538-4361
- Fax
- (715) 538-2912
- NPI assigned
- Sep 21, 2006
- 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 | 2950-33 | WI | Primary |
Addresses
Primary practice location
18601 Lincoln St
Whitehall, WI 54773-8605
Mailing address
1251 E Wilson Ave
Arcadia, WI 54612-1830
Phone (608) 323-7005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 2, 2022 through May 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2950-33 | WI | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841398765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1251 E WILSON AVE",
"city": "ARCADIA",
"state": "WI",
"postal_code": "546121830",
"telephone_number": "608-323-7005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18601 LINCOLN ST",
"city": "WHITEHALL",
"state": "WI",
"postal_code": "547738605",
"telephone_number": "715-538-4361",
"fax_number": "715-538-2912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDQUIST",
"first_name": "DEBRA",
"middle_name": "LYNN",
"credential": "APRN-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WI",
"license": "2950-33",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Whitehall, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.