Active NPI
Roberta Gwillim
- Adult Psychiatric/Mental Health Registered Nurse
- Marion, IN
National Provider Identifier
1972242899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Psychiatric/Mental Health Registered Nurse
- License
- 28166704A
- Practice address
- 1700 E 38TH St
Marion, IN 46953-4568 - Phone
- (765) 674-3321
- NPI assigned
- May 31, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Adult Psychiatric/Mental Health Registered Nurse | 163WP0809X | 28166704A | IN | Primary |
Addresses
Primary practice location
1700 E 38TH St
Marion, IN 46953-4568
Mailing address
5208 S 400 W
Wabash, IN 46992-8235
Phone (765) 674-3321
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
| License | State | Type | Specialty |
|---|---|---|---|
| 28166704A | IN | MD | Adult Psychiatric/Mental Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653955200000",
"number": "1972242899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5208 S 400 W",
"city": "WABASH",
"state": "IN",
"postal_code": "469928235",
"telephone_number": "765-674-3321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 E 38TH ST",
"city": "MARION",
"state": "IN",
"postal_code": "469534568",
"telephone_number": "765-674-3321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GWILLIM",
"first_name": "ROBERTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-31",
"last_updated": "2022-05-31",
"certification_date": "2022-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0809X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
"state": "IN",
"license": "28166704A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marion, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.