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1215332705 NPI number — PATRICIA ANNE WAGNER

NPI Number: 1215332705
Health Care Provider/Practitioner: PATRICIA ANNE WAGNER

Information about “1215332705” NPI (PATRICIA ANNE WAGNER) exists in 1215332705 in HTML format HTML  |  1215332705 in plain Text format TXT  |  1215332705 in PDF (Portable Document Format) PDF  |  1215332705 in an XML format XML  formats.

NPI Number : 1215332705 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215332705",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WAGNER",
    "FirstName": "PATRICIA",
    "MiddleName": "ANNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HUSSON",
    "OtherFirstName": "PATRICIA",
    "OtherMiddleName": "ANNE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1401 BLACKFOOT TRL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WOODLAND PARK",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80863-8304",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "719-686-1938",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1401 BLACKFOOT TRL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WOODLAND PARK",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80863-8304",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "719-686-1938",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/27/2014",
    "LastUpdateDate": "10/27/2014",
    "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": "2255R0406X",
          "TaxonomyName": "Blind Rehabilitation Specialist/Technologist",
          "LicenseNumber": "3348",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225CX0006X",
          "TaxonomyName": "Orientation and Mobility Training Rehabilitation Counselor",
          "LicenseNumber": "3518",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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