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1073285508 NPI number — NICOLE M WOLLE

NPI Number: 1073285508
Health Care Provider/Practitioner: NICOLE M WOLLE

Information about “1073285508” NPI (NICOLE M WOLLE) exists in 1073285508 in HTML format HTML  |  1073285508 in plain Text format TXT  |  1073285508 in PDF (Portable Document Format) PDF  |  1073285508 in an XML format XML  formats.

NPI Number : 1073285508 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073285508",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WOLLE",
    "FirstName": "NICOLE",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FOWLER",
    "OtherFirstName": "NICOLE",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "CNP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "8170 33RD AVE S # MS 21110Q",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MINNEAPOLIS",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55425-4516",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "14701 VICTOR HUGO BLVD N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HUGO",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55038-4561",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "952-883-8800",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/03/2021",
    "LastUpdateDate": "11/29/2022",
    "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": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "8597",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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