NPI Code Detail JSON Logo

1033430384 NPI number — ANN M VAN DE WAL PHARMD

NPI Number: 1033430384
Health Care Provider/Practitioner: ANN M VAN DE WAL PHARMD

Information about “1033430384” NPI (ANN M VAN DE WAL PHARMD) exists in 1033430384 in HTML format HTML  |  1033430384 in plain Text format TXT  |  1033430384 in PDF (Portable Document Format) PDF  |  1033430384 in an XML format XML  formats.

NPI Number : 1033430384 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033430384",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VAN DE WAL",
    "FirstName": "ANN",
    "MiddleName": "M",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1256 ALBANY ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "UTICA",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "13501-4252",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1256 ALBANY ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "UTICA",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "13501-4252",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "315-735-1400",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/21/2010",
    "LastUpdateDate": "06/21/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "20054531",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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