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1295718278 NPI number — THERESA M WU P.A.-C.

NPI Number: 1295718278
Health Care Provider/Practitioner: THERESA M WU P.A.-C.

Information about “1295718278” NPI (THERESA M WU P.A.-C.) exists in 1295718278 in HTML format HTML  |  1295718278 in plain Text format TXT  |  1295718278 in PDF (Portable Document Format) PDF  |  1295718278 in an XML format XML  formats.

NPI Number : 1295718278 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295718278",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WU",
    "FirstName": "THERESA",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "P.A.-C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HAVEMAN",
    "OtherFirstName": "THERESA",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6541 N MONTROSE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TUCSON",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85741-3124",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "602-769-0574",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "627 N SWAN RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TUCSON",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85711-2101",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "520-308-8990",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/23/2005",
    "LastUpdateDate": "04/10/2020",
    "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": "363AM0700X",
        "TaxonomyName": "Medical Physician Assistant",
        "LicenseNumber": "2453",
        "LicenseNumberStateCode": "AZ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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