MALISSA R WIGHTMAN (NPI# 1063631083) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063631083 |
| Entity Type | Individual |
| Full Name | MALISSA R WIGHTMAN |
| Credential | RN, APNP |
| Practice Address |
2825 Prairie Ave Beloit WI 53511-1844 |
| Practice Telephone | 6083635500 |
| Mailing Telephone | 6083635500 |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
113626 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
1069 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 43880300 | 05 |
| Street Address |
2825 PRAIRIE AVE |
| City | BELOIT |
| State | WI |
| Zip Code | 53511-1844 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427024678 | Karla J. Degarmo-haakenson | Counselor | 2825 Prairie Ave, Beloit, WI 53511-1844 | 2006-02-27 |
| 1487196895 | Erika Leigh Bourdeaux | Nurse Practitioner | 2825 Prairie Ave, Beloit, WI 53511-1844 | 2016-11-16 |
| 1376096768 | Natalie J. Parker | Registered Nurse | 2825 Prairie Ave, Beloit, WI 53511-1844 | 2016-08-02 |
| 1003256975 | Imad M. Aziz | Family Medicine | 2825 Prairie Ave, Beloit, WI 53511-1844 | 2013-06-25 |
| 1124366265 | Charles E Kramarczyk | Prosthetist | 2825 Prairie Ave, Beloit, WI 53511-1844 | 2013-01-24 |
| 1700169372 | Brian W Turman | Prosthetist | 2825 Prairie Ave, Beloit, WI 53511 | 2011-09-21 |
| 1699922286 | Martin L Batson | Orthotist | 2825 Prairie Ave, Beloit, WI 53511-1844 | 2008-08-26 |
| 1134376486 | Elana Fran Wistrom | Obstetrics & Gynecology | 2825 Prairie Ave, Beloit, WI 53511-1844 | 2008-08-19 |
| 1780857508 | Emarcia Patrice Peete | Pediatrics | 2825 Prairie Ave, Beloit, WI 53511-1844 | 2008-04-13 |
| 1619000437 | Mercy Health System Corporation | Durable Medical Equipment & Medical Supplies | 2825 Prairie Ave, Beloit, WI 53511-1844 | 2007-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730738485 | Linda Lee Cook | Technician | 914 Cranston Rd., Beloit, WI 53511 | 2019-09-05 |
| 1033773734 | Holistic Counseling Services, LLC | Counselor | 1517 Huebbe Parkway, Ste A, Beloit, WI 53511 | 2019-04-28 |
| 1578073870 | Bonita May Cooke | Counselor | 838 Grant St., Beloit, WI 53511 | 2017-10-02 |
| 1679091219 | Stacy Lynn Gallagher | Licensed Practical Nurse | 1060 Bittel St, Beloit, WI 53511 | 2017-09-04 |
| 1629448824 | Brenda Jean Allen | Registered Nurse | 2907 E. Leona Drive, Beloit, WI 53511 | 2015-09-30 |
| 1033595038 | Amber Noel Slaybaugh | Physical Therapist | 838 E. Azalea Ter., Beloit, WI 53511 | 2015-08-03 |
| 1407260326 | Quirt Family Dentistry, Sc | Dentist | 2777 Milwaukee Rd, Beloit, WI 53511 | 2014-06-18 |
| 1821436973 | Raymond K Spade | Counselor | 2240 Prairie Ave., Beloit, WI 53511 | 2013-06-11 |
| 1629321658 | Sarah Ann Nelson | Physical Therapist | 1905 W. Hart Road, Beloit, WI 53511 | 2012-10-15 |
| 1235494212 | Mary Ann Hudson | Nurse Practitioner | 700 College Street, Beloit College, Beloit, WI 53511 | 2012-07-06 |
| Find all providers in zip 53511 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487196895 | Erika Leigh Bourdeaux | Nurse Practitioner | 2825 Prairie Ave, Beloit, WI 53511-1844 | 2016-11-16 |
| 1629215322 | Tracy Ellen Saladar | Nurse Practitioner | 74 Eclipse Ctr, Beloit, WI 53511-3550 | 2009-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275159964 | Caitlin West | Nurse Practitioner | 10823 N Ravine Ct, Mequon, WI 53092-5876 | 2020-06-18 |
| 1639704166 | Angelica Shanahan | Nurse Practitioner | 8733 W Watertown Plank Rd, Milwaukee, WI 53226-3548 | 2020-03-04 |
| 1609408210 | Jenna Rae Eisold | Nurse Practitioner | 65 W Wood Ridge Dr, River Falls, WI 54022-8291 | 2020-02-11 |
| 1639685274 | Laura Palmer | Nurse Practitioner | 4855 S Moorland Rd # Rod, New Berlin, WI 53151-7494 | 2017-12-19 |
| 1306356589 | Alexandra Wilson | Nurse Practitioner | 3033 W Layton Ave # 102, Greenfield, WI 53221-2628 | 2017-10-02 |
| 1689192775 | Brigid Mary Costello | Nurse Practitioner | 9000 W Wisconsin Ave Ste 620, Milwaukee, WI 53226-4874 | 2017-09-08 |
| 1851643696 | Jamie Harder | Nurse Practitioner | 2574 Sun Valley Dr Ste 207, Delafield, WI 53018-2334 | 2012-10-03 |
| 1760731988 | Nancy J Thompson-quandt | Nurse Practitioner | 7831 Warren Ave, Wauwatosa, WI 53213-2115 | 2012-09-04 |
| 1932471018 | Marie Helen Dietrich | Nurse Practitioner | 201 S Gammon Rd, Madison, WI 53717-1404 | 2012-02-03 |
| 1598993925 | Rebecca R. Rusch | Nurse Practitioner | 13950 W. W. Capitol Drive, Suite 200, Brookfield, WI 53005-2441 | 2009-06-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.