NPI Code Detail JSON Logo

1104276948 NPI number — ALICIA ANNE VANDEWALLE APRN

NPI Number: 1104276948
Health Care Provider/Practitioner: ALICIA ANNE VANDEWALLE APRN

Information about “1104276948” NPI (ALICIA ANNE VANDEWALLE APRN) exists in 1104276948 in HTML format HTML  |  1104276948 in plain Text format TXT  |  1104276948 in PDF (Portable Document Format) PDF  |  1104276948 in an XML format XML  formats.

NPI Number : 1104276948 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104276948",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VANDEWALLE",
    "FirstName": "ALICIA",
    "MiddleName": "ANNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "APRN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MAVIS",
    "OtherFirstName": "ALICIA",
    "OtherMiddleName": "ANNE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "APRN",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 429",
    "SecondLineMailingAddress": "402 N MAPLE",
    "MailingAddressCityName": "OSMOND",
    "MailingAddressStateName": "NE",
    "MailingAddressPostalCode": "68765-0429",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "402-748-3393",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "106 E WAYNE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RANDOLPH",
    "PracticeLocationAddressStateName": "NE",
    "PracticeLocationAddressPostalCode": "68771-5300",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "402-337-0200",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/13/2016",
    "LastUpdateDate": "08/19/2022",
    "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": "112022",
        "LicenseNumberStateCode": "NE",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2025 Data Labs Health. All rights reserved.