Mary Allison Wetzel, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

129500 Issued in MO

Practice address

603 E Gaines Dr
Clinton, MO 64735-3205

Phone

(660) 885-8141

Fax

(660) 885-5815

NPI assigned

Jan 15, 2007

Last updated

Feb 8, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Mary Allison Leach Former name

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Golden Valley Memorial Hospital District

  dba Golden Valley Medical - Clinton

  • Rural Health Clinic/Center
  • Clinton, MO
  • NPI 1003873266
  Medicare reassignment NPD
• Golden Valley Memorial Hospital District

  dba Golden Valley Medical - Osceola

  • Rural Health Clinic/Center
  • Osceola, MO
  • NPI 1124437918
  NPD
• Golden Valley Memorial Hospital District

  dba GVMH Medical East

  • Clinic/Center
  • Clinton, MO
  • NPI 1396379830
  NPD

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518048000000",
    "number": "1881745131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 E. 104TH ST.",
            "address_2": "MAILSTOP 400N",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "64131",
            "telephone_number": "816-502-7104",
            "fax_number": "816-932-9670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 E GAINES DR",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647353205",
            "telephone_number": "660-885-8141",
            "fax_number": "660-885-5815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WETZEL",
        "first_name": "MARY",
        "middle_name": "ALLISON",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2018-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "129500",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "129500",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "916844301",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "LEACH",
            "middle_name": "ALLISON",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kelly May Wenberg, CSFA
• Kirsten Weston, M.S. CF-SLP
• Mallory Westover, SLPA
• Carroll Robert Wetzel, M.D.
• Gus S Wetzel II
• Kristie Diane Wever, PLPC
• Emilee Wheeler
• Faith Wheeler, RBT
• Mayci Rose Wheeler, RDH
• Lacey Wiggins, RBT

• Certified Registered Nurse Anesthetist in Clinton, MO
• Providers in Clinton, MO by specialty
• Certified Registered Nurse Anesthetist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.