Maria Theresa Liceralde Wyson, MSN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

21360 Issued in CA

Practice address

7811 Laguna Blvd Ste 161
Elk Grove, CA 95758-7949

Phone

(916) 877-7778

Fax

(916) 896-1286

NPI assigned

Nov 22, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Maria Theresa Sideco Liceralde Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

May accept Medicare assignment

Group practices

American River Urgent Care IncGroup PAC ID 5890050900, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• American River Urgent Care, Inc

  • Urgent Care Clinic/Center
  • Orangevale, CA
  • NPI 1598279085
  Medicare reassignment Care Compare group NPD
• Alshifa Medical Group Inc

  dba Trinity Urgent Care & Occupational Health

  • Urgent Care Clinic/Center
  • Stockton, CA
  • NPI 1093960403
  Medicare reassignment NPD
• Afato Medical Corporation

  dba Regency Urgent Care

  • Family Medicine Physician
  • Yuba City, CA
  • NPI 1134142524
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1861769648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11592 LINDAY WAY",
            "city": "GOLD RIVER",
            "state": "CA",
            "postal_code": "956706233",
            "telephone_number": "916-213-2570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7811 LAGUNA BLVD STE 161",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957587949",
            "telephone_number": "916-877-7778",
            "fax_number": "916-896-1286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYSON",
        "first_name": "MARIA THERESA",
        "middle_name": "LICERALDE",
        "credential": "MSN, FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-22",
        "last_updated": "2023-03-07",
        "certification_date": "2021-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "21360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIA THERESA",
            "last_name": "LICERALDE",
            "middle_name": "SIDECO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nathan Wright, PSYD
• Parker Wright
• Chou Ying Wu, MD
• Jamson Wu, DDS, MSD
• Misganaw Kassie Wubneh
• Nathan Xavier
• Shirley Xian
• Mario Ximenez, PT, DPT
• Victoria Merie Ximenez
• Xiong Chiropractic P.C. (Precision Family Chiropractic)

• Family Nurse Practitioner in Elk Grove, CA
• Providers in Elk Grove, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.