Active NPI
Shelly Jean Mullikin
- Pharmacist
- Burlington, WI
National Provider Identifier
1982097663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11046
- Practice address
- 210 S Pine St
Burlington, WI 53105-1914 - Phone
- (262) 763-7177
- Fax
- (262) 763-9860
- NPI assigned
- Mar 5, 2015
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11046 | WI | Primary |
Addresses
Primary practice location
210 S Pine St
Burlington, WI 53105-1914
Mailing address
210 S Pine St
Burlington, WI 53105-1914
Phone (262) 763-7177
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 318362 | Other | WI | NABP |
Other names 1
- Shelly Jean Wuttke
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 |
|---|---|---|---|
| 11046 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1425513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425513600000",
"number": "1982097663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 S PINE ST",
"city": "BURLINGTON",
"state": "WI",
"postal_code": "531051914",
"telephone_number": "262-763-7177",
"fax_number": "262-763-9860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 S PINE ST",
"city": "BURLINGTON",
"state": "WI",
"postal_code": "531051914",
"telephone_number": "262-763-7177",
"fax_number": "262-763-9860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLIKIN",
"first_name": "SHELLY",
"middle_name": "JEAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-03-05",
"last_updated": "2015-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "11046",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NABP",
"identifier": "318362",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SHELLY",
"last_name": "WUTTKE",
"middle_name": "JEAN",
"credential": "RPH",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Burlington, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.