Individual provider Active NPI

Marian Quimimanles Mettle

  • Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1912416850
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
173501-30 Issued in WI
Practice address
1710 S 7TH St
Milwaukee, WI 53204-3538
Phone
(414) 645-8383
NPI assigned
Sep 22, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 173501-30 WI Primary

Addresses

Primary practice location

1710 S 7TH St
Milwaukee, WI 53204-3538

Mailing address

1710 S 7TH St
Milwaukee, WI 53204-3538
Phone (414) 645-8383

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

State licenses

LicenseStateTypeSpecialty
173501-30WIMDNurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1506038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1912416850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 S 7TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532043538",
            "telephone_number": "414-645-8383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 S 7TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532043538",
            "telephone_number": "414-645-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "METTLE",
        "first_name": "MARIAN",
        "middle_name": "QUIMIMANLES",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-22",
        "last_updated": "2022-07-21",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "173501-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.