NPI Code Detail JSON Logo

1215880513 NPI number — BETH WANGELIN PE70100159

NPI Number: 1215880513
Health Care Provider/Practitioner: BETH WANGELIN PE70100159

Information about “1215880513” NPI (BETH WANGELIN PE70100159) exists in 1215880513 in HTML format HTML  |  1215880513 in plain Text format TXT  |  1215880513 in PDF (Portable Document Format) PDF  |  1215880513 in an XML format XML  formats.

NPI Number : 1215880513 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215880513",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WANGELIN",
    "FirstName": "BETH",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PE70100159",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 1299",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BATTLE GROUND",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98604-1299",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "844-777-9242",
    "MailingAddressFaxNumber": "360-397-7477",
    "FirstLinePracticeLocationAddress": "21810 NE 37TH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIDGEFIELD",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98642-7747",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "844-777-9242",
    "PracticeLocationAddressFaxNumber": "360-397-7477",
    "EnumerationDate": "02/17/2026",
    "LastUpdateDate": "02/17/2026",
    "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": "175T00000X",
        "TaxonomyName": "Peer Specialist",
        "LicenseNumber": "PE70100159",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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