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1043977564 NPI number — ELLIE WOLFENDEN

NPI Number: 1043977564
Health Care Provider/Practitioner: ELLIE WOLFENDEN

Information about “1043977564” NPI (ELLIE WOLFENDEN) exists in 1043977564 in HTML format HTML  |  1043977564 in plain Text format TXT  |  1043977564 in PDF (Portable Document Format) PDF  |  1043977564 in an XML format XML  formats.

NPI Number : 1043977564 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043977564",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WOLFENDEN",
    "FirstName": "ELLIE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "350 NEW FIDELITY CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GARNER",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27529-2665",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "919-258-2714",
    "MailingAddressFaxNumber": "410-648-4878",
    "FirstLinePracticeLocationAddress": "701 SAVANNAH RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LEWES",
    "PracticeLocationAddressStateName": "DE",
    "PracticeLocationAddressPostalCode": "19958-1550",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "302-644-2530",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/18/2021",
    "LastUpdateDate": "03/28/2022",
    "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": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "J1-0014484",
        "LicenseNumberStateCode": "DE",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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