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1093822975 NPI number — TANYA WOLLNER APNP

NPI Number: 1093822975
Health Care Provider/Practitioner: TANYA WOLLNER APNP

Information about “1093822975” NPI (TANYA WOLLNER APNP) exists in 1093822975 in HTML format HTML  |  1093822975 in plain Text format TXT  |  1093822975 in PDF (Portable Document Format) PDF  |  1093822975 in an XML format XML  formats.

NPI Number : 1093822975 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093822975",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WOLLNER",
    "FirstName": "TANYA",
    "MiddleName": null,
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "APNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ZBOROVSKY",
    "OtherFirstName": "TANYA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "3",
    "FirstLineMailingAddress": "PO BOX 735044",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60673-5044",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "414-649-3240",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2801 W KINNICKINNIC RIVER PKWY",
    "SecondLinePracticeLocationAddress": "#525",
    "PracticeLocationAddressCityName": "MILWAUKEE",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53215",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "414-385-2550",
    "PracticeLocationAddressFaxNumber": "414-649-5414",
    "EnumerationDate": "08/24/2006",
    "LastUpdateDate": "11/10/2023",
    "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": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "129052-030",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "2300-033",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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