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1134318694 NPI number — WANDA GAIL LAGRONE L.D.O.

NPI Number: 1134318694
Health Care Provider/Practitioner: WANDA GAIL LAGRONE L.D.O.

Information about “1134318694” NPI (WANDA GAIL LAGRONE L.D.O.) exists in 1134318694 in HTML format HTML  |  1134318694 in plain Text format TXT  |  1134318694 in PDF (Portable Document Format) PDF  |  1134318694 in an XML format XML  formats.

NPI Number : 1134318694 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134318694",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LAGRONE",
    "FirstName": "WANDA",
    "MiddleName": "GAIL",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "L.D.O.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "712 E 69TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAVANNAH",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "31405-4716",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "912-354-6445",
    "MailingAddressFaxNumber": "912-354-3393",
    "FirstLinePracticeLocationAddress": "712 E 69TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAVANNAH",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31405-4716",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "912-354-6445",
    "PracticeLocationAddressFaxNumber": "912-354-3393",
    "EnumerationDate": "10/22/2007",
    "LastUpdateDate": "10/22/2007",
    "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": "156FX1800X",
        "TaxonomyName": "Optician",
        "LicenseNumber": "1041",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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