Active NPI
Marcia Joan Kooiman
- Licensed Practical Nurse
- Delavan, WI
National Provider Identifier
1992297774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 23536-031
- Practice address
- N3187 Elm Ridge Rd
Delavan, WI 53115-3104 - Phone
- (262) 325-5645
- NPI assigned
- Jun 6, 2018
- 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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 23536-031 | WI | Primary |
Addresses
Primary practice location
N3187 Elm Ridge Rd
Delavan, WI 53115-3104
Mailing address
N3187 Elm Ridge Rd
Delavan, WI 53115-3104
Phone (262) 325-5645
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 |
|---|---|---|---|
| 23536-031 | WI | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528243200000",
"number": "1992297774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N3187 ELM RIDGE RD",
"city": "DELAVAN",
"state": "WI",
"postal_code": "531153104",
"telephone_number": "262-325-5645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N3187 ELM RIDGE RD",
"city": "DELAVAN",
"state": "WI",
"postal_code": "531153104",
"telephone_number": "262-325-5645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOOIMAN",
"first_name": "MARCIA",
"middle_name": "JOAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-06",
"last_updated": "2018-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Licensed Practical Nurse",
"state": "WI",
"license": "23536-031",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Delavan, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.