Provider Demographics
NPI: | 1659780708 |
---|---|
Name: | CARDINAL ELEMENTS INC |
Entity Type: | Organization |
Organization Name: | CARDINAL ELEMENTS INC |
Other - Org Name: | MARY ANN WIETBROCK, CNS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CLINICAL NURSE SPECIALIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARY ANN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WIETBROCK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN MSN CNS |
Authorized Official - Phone: | 317-410-9140 |
Mailing Address - Street 1: | 4108 W 400 S |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW PALESTINE |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46163-9612 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-410-9140 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4108 W 400 S |
Practice Address - Street 2: | |
Practice Address - City: | NEW PALESTINE |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46163-9612 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-410-9140 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-08-02 |
Last Update Date: | 2014-08-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 28088637A | 163WC1500X, 364S00000X, 364SC1501X, 364SC2300X, 364SH0200X, 364SH1100X, 364SM0705X, 364SS0200X, 364SX0106X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 364SC1501X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Community Health/Public Health | Group - Single Specialty |
No | 163WC1500X | Nursing Service Providers | Registered Nurse | Community Health | Group - Single Specialty |
No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Group - Single Specialty | |
No | 364SC2300X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Chronic Care | Group - Single Specialty |
No | 364SH0200X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Home Health | Group - Single Specialty |
No | 364SH1100X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Holistic | Group - Single Specialty |
No | 364SM0705X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Medical-Surgical | Group - Single Specialty |
No | 364SS0200X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | School | Group - Single Specialty |
No | 364SX0106X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Occupational Health | Group - Single Specialty |