Active NPI
Sandra J Packard, NP
- Nurse Practitioner
- Mondovi, WI
National Provider Identifier
1922068857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 97815
- Practice address
- 700 Buffalo St
Mondovi, WI 54755-1371 - Phone
- (715) 838-5222
- NPI assigned
- Mar 24, 2006
- Last updated
- Apr 30, 2009
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 97815 | WI | Primary |
Addresses
Primary practice location
700 Buffalo St
Mondovi, WI 54755-1371
Mailing address
PO Box 1510
Eau Claire, WI 54702-1510
Phone (715) 838-5222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43860100 | 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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241049600000",
"number": "1922068857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1510",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "547021510",
"telephone_number": "715-838-5222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 BUFFALO ST",
"city": "MONDOVI",
"state": "WI",
"postal_code": "547551371",
"telephone_number": "715-838-5222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACKARD",
"first_name": "SANDRA",
"middle_name": "J",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-24",
"last_updated": "2009-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "97815",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43860100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mondovi, WI
- William R. Moos, D.D.S.
- Mountain Dental of New Mexico PC (Mountain Dental)
- Nancy Polzer Hearing Aid Services
- Jenna Ruth Nehls, PHARMD
- Nancy Alice Olson-Bauer, P.T.
- Lisa Jane Palecek, IHP
- Robert Melvin Pederson, D.D.S.
- Pharmacare LTD (Mondovi Pharmacy)
- Pharmacare LTD (Mondovi Pharmacy)
- Desiree Phillips, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.