MARIETTA E ENRIQUEZ (NPI# 1124099353) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124099353 |
| Entity Type | Individual |
| Full Name | MARIETTA E ENRIQUEZ |
| Credential | M.D. |
| Practice Address |
3015 Wilson Ave Louisville KY 40211-1969 |
| Practice Telephone | 5027744401 |
| Mailing Telephone | 5027744401 |
| Mailing Fax Number | 5027728983 |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2019-06-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 22441 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | MEDICARE | K215580 | 01 |
| KY | 64224413 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 305 W Broadway, Suite 104, Louisville, KY 402022129 | 5025852924 | 5025852931 |
| Street Address |
3015 WILSON AVE |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40211-1969 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275534091 | Lisa G Glass | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2005-08-02 |
| 1083215362 | Yazmine Jaquez | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-11-04 |
| 1982211405 | Domini Williams | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-09-29 |
| 1497361091 | Treana Redd | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-09-18 |
| 1356954366 | Janneve Sankawulo | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-28 |
| 1588274260 | Robyn May | Dentist | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-06 |
| 1124638184 | Symone Stephens | Registered Nurse | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-05 |
| 1275151292 | Park Duvalle Community Health Center, Inc | Clinic/Center | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-07-07 |
| 1598312415 | Elissa Grider | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2019-08-26 |
| 1730733783 | Mark A Bush | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211 | 2019-07-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942792940 | Kare LLC | Dentist | 2500 W Broadway Ste 500, Louisville, KY 40211 | 2018-06-05 |
| 1265943716 | Practicare Home Care Services, LLC | Nurse Practitioner | 1667 Russell Lee Dr, Louisville, KY 40211 | 2017-10-23 |
| 1518478221 | Latoya Samantha Hall | Counselor | 646 South 36th Street, Louisville, KY 40211 | 2017-10-20 |
| 1003071200 | Mark Cassol Md Psc | Ophthalmology | 2600 W. Broadway, Suite 105, Louisville, KY 40211 | 2008-07-28 |
| 1194919548 | Hardin Housing Corp | Assisted Living Facility | 2035 S 41st St, Louisville, KY 40211 | 2007-08-29 |
| 1184770562 | Eta Day Care Center LLC | Case Management | 724 So 44th Street, Louisville, KY 40211 | 2007-01-26 |
| 1871571356 | Alice C Gunnison | Physician Assistant | 2406 West Broadway, Jencare Neighborhood Medical Center West Broadway, LLC, Louisville, KY 40211 | 2006-01-05 |
| 1730694266 | Orchid House, Inc. | Early Intervention Provider Agency | 703 S 31st St, Louisville, KY 40211 | 2017-12-06 |
| 1891188785 | Mary Jo Pitts | Registered Nurse | 2406 West Broadway, Jencare Neighborhood Medical Center West Broadway, LLC, Louisville, KY 40211 | 2015-03-17 |
| 1164717492 | Priscilla Nana Ama Owusu | Internal Medicine | 2406 W Broadway, Louisville, KY 40211 | 2011-06-15 |
| Find all providers in zip 40211 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306316989 | Jacquee L Mcnear | Pediatrics | 801 Barret Avenue Suite 314, Louisville, KY 40204-1701 | 2018-11-27 |
| 1902292857 | Hayley Redmond | Pediatrics | 571 S Floyd St Ste 332, Louisville, KY 40202 | 2015-04-07 |
| 1770978512 | Michael Bricken | Pediatrics | 760 S Hancock St # B100, Louisville, KY 40203 | 2015-03-30 |
| 1114332236 | Amanda Brian Rogers | Pediatrics | 411 E Chestnut St # Street6, Louisville, KY 40202-1713 | 2014-06-26 |
| 1770900144 | Kathryn Thorne | Pediatrics | 9710 Park Plaza Ave Unit 107, Louisville, KY 40241-2292 | 2014-03-24 |
| 1669717690 | Surjeet Singh Dhanjal | Pediatrics | 1506 Thackeray Dr, Louisville, KY 40205-2410 | 2012-12-03 |
| 1164656443 | Betty Sue Spivack | Pediatrics | 8804 Nottingham Pkwy, Louisville, KY 40222-5217 | 2009-05-14 |
| 1821238528 | James Grant Mumford | Pediatrics | 5100 Commerce Crossings Dr, Louisville, KY 40229-2128 | 2009-02-20 |
| 1033371216 | Jonathan R Malowitz | Pediatrics | 4123 Dutchmans Lane Suite 301, Suburban Medical Plaza 3, Louisville, KY 40207 | 2008-06-27 |
| 1356509954 | Julia Lane Mitchell | Pediatrics | 760 S. Hancock St, B100, Louisville, KY 40203 | 2008-05-30 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40211 |
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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.