MARY SUSAN SHICK (NPI# 1992733240) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992733240 |
| Entity Type | Individual |
| Full Name | MARY SUSAN SHICK |
| Other Name | MARY SUSAN WATTS |
| Credential | MSN, ANP |
| Practice Address |
421 W 1st St Bloomington IN 47403-2403 |
| Practice Telephone | 8123360168 |
| Practice Fax Number | 8123357372 |
| Mailing Telephone | 8123360168 |
| Mailing Fax Number | 8123357372 |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2008-05-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WG0000X |
Registered Nurse Specialization: General Practice |
28090755A | IN | Nursing Service Providers |
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
71000080A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200076820A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568828226 | Mary Shick | Nurse Practitioner | 2835 Fort Missoula Rd Ste 200, Physicians Building No. 3, Missoula, MT 59804-7424 | 2016-01-11 |
| Street Address |
421 W 1ST ST |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47403-2403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124089313 | Camilo Santiago | Surgery | 421 W 1st St, Bloomington, IN 47403 | 2006-03-29 |
| 1376053652 | Lindsey R Williams | Nurse Practitioner | 421 W 1st St, Bloomington, IN 47403-2403 | 2017-10-02 |
| 1396188819 | Katherine Elizabeth Smiley | Surgery | 421 W 1st St, Bloomington, IN 47403 | 2013-04-15 |
| 1902132558 | Michele Leigh Yarbrough | Nurse Practitioner | 421 W 1st St, Bloomington, IN 47403-2403 | 2009-11-02 |
| 1518122050 | Robert Sung | Surgery | 421 W 1st St, Bloomington, IN 47403-2403 | 2008-07-24 |
| 1437313764 | Alison C Heidt | Surgery | 421 W 1st St, Bloomington, IN 47403-2403 | 2008-07-16 |
| 1639208747 | Jason Winfield Kennard | Surgery | 421 W 1st St, Bloomington, IN 47403-2403 | 2007-03-05 |
| 1144310301 | Charles R. Mckeen IIi | Surgery | 421 W 1st St, Bloomington, IN 47403-2403 | 2006-10-16 |
| 1558391144 | Martha Lee Matthews | Counselor | 421 W 1st St, Bloomington, IN 47403-2403 | 2006-07-03 |
| 1205863321 | Leland R Matthews | Obstetrics & Gynecology | 421 W 1st St, Bloomington, IN 47403-2403 | 2006-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043783673 | Brook Whitaker | Registered Nurse | 4011 S. Monroe Medical Park Blvd, Bloomington, IN 47403 | 2019-01-07 |
| 1598251175 | Jacob Edward Lundorf | Nurse Practitioner | 2100 S Liberty Dr Ste B, Bloomington, IN 47403 | 2018-07-06 |
| 1568973717 | Gregory Thomas Dougan | Physician Assistant | 418 South Landmark Avenue, Bloomington, IN 47403 | 2017-10-16 |
| 1295276160 | Indiana Center for Recovery, LLC | Substance Abuse Rehabilitation Facility | 1004 W 1st Street, Bloomington, IN 47403 | 2017-03-13 |
| 1144694217 | Kayla Dewolf | Specialist/Technologist | 1471 W Allen St, Bloomington, IN 47403 | 2015-11-30 |
| 1164806444 | Monroe Hosoital | General Acute Care Hospital | 4011 Monroe Medical Park, Bloomington, IN 47403 | 2015-07-16 |
| 1821411588 | Jennifer Turner | Occupational Therapy Assistant | 1023 West Main St, Swiss Villa, Vevay, IN 47403 | 2014-01-30 |
| 1104170232 | Kendall Basore | Social Worker | 445 S. Landmark Ave., Bloomington, IN 47403 | 2012-10-26 |
| 1568715886 | Indiana Hearing LLC | Hearing Aid Equipment | 2019 S Liberty Dr, Bloomington, IN 47403 | 2012-10-24 |
| 1679870232 | Accurate Hearing Services | Clinic/Center | 1355 W Second St, #3, Bloomington, IN 47403 | 2011-02-17 |
| Find all providers in zip 47403 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346760253 | Elizabeth Devlin | Nurse Practitioner | 25 Long Cove Ct, Bloomington, IL 61704 | 2017-06-21 |
| 1962588657 | Cecelia L Smith | Nurse Practitioner | 637 S Walker, Suite 2, Bloomington, IN 47403-2175 | 2006-10-27 |
| 1942392675 | Bradley J Cole | Nurse Practitioner | 2406 East Empire, Bloomington, IL 61704 | 2006-09-29 |
| 1205364494 | Hena Naz Shah | Nurse Practitioner | 550 S Landmark Ave, Bloomington, IN 47403-3239 | 2017-06-01 |
| 1730616756 | Julia Dmitri Jesme | Nurse Practitioner | 8600 Nicollet Ave S, Bloomington, MN 55420-2824 | 2017-05-22 |
| 1275914020 | Jaclyn Rose Guetzko | Nurse Practitioner | 7920 Old Cedar Ave S, Bloomington, MN 55425-1207 | 2015-06-17 |
| 1548669112 | Jennifer Phelps | Nurse Practitioner | 455 S Landmark Ave, Bloomington, IN 47403-5004 | 2014-08-19 |
| 1497181507 | Lindsey Ann Mehran-rezaii | Nurse Practitioner | 8101 34th Ave S, Ms26602g, Bloomington, MN 55425-1692 | 2013-09-20 |
| 1487901997 | Angela Vogt | Nurse Practitioner | 601 W 2nd St, Bloomington, IN 47403-2317 | 2012-08-14 |
| 1962711333 | Kathleen P Price | Nurse Practitioner | 550 S Landmark Ave, Bloomington, IN 47403-3239 | 2010-10-01 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 47403 |
Please comment or provide details below to improve the information on MARY SUSAN SHICK.
| 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.