Mary Anne Putt, N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704098741 Issued in MI

Practice address

1480 W Center Rd
Suite 5
Essexville, MI 48732-2143

Phone

(989) 894-4625

Fax

(989) 494-4626

NPI assigned

Jan 23, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1992859250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S BALLENGER HWY",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323638",
            "telephone_number": "810-342-1000",
            "fax_number": "810-342-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 W CENTER RD",
            "address_2": "SUITE 5",
            "city": "ESSEXVILLE",
            "state": "MI",
            "postal_code": "487322143",
            "telephone_number": "989-894-4625",
            "fax_number": "989-494-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUTT",
        "first_name": "MARY",
        "middle_name": "ANNE",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704098741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "P00213438CN5519",
            "identifier": "METRAHEALTH",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5008702430",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4579356",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN",
            "identifier": "1011985",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taegan Alycia Pletzke, FNP-BC
• Podcare PC
• Kayle Rose Polega, MSOT, OTRL
• Misty Potts, RDN
• Hailee Maree Prahl
• Victor Putz, DPM
• Rite Aid of Michigan Inc (Rite Aid Pharmacy 01573)
• Galia Rizova
• John Roberts, PA-C
• Jessica Hope Ross

• Nurse Practitioner in Essexville, MI
• Providers in Essexville, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.