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1104537158 NPI number — EMMA KATE DEWANE PA

NPI Number: 1104537158
Health Care Provider/Practitioner: EMMA KATE DEWANE PA

Information about “1104537158” NPI (EMMA KATE DEWANE PA) exists in 1104537158 in HTML format HTML  |  1104537158 in plain Text format TXT  |  1104537158 in PDF (Portable Document Format) PDF  |  1104537158 in an XML format XML  formats.

NPI Number : 1104537158 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104537158",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DEWANE",
    "FirstName": "EMMA",
    "MiddleName": "KATE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "719 W HAMILTON AVE STE B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAU CLAIRE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54701-6970",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "855 LAKELAND DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHIPPEWA FALLS",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54729-1687",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "715-726-9248",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/12/2022",
    "LastUpdateDate": "04/01/2025",
    "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": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "7214-23",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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