NPI Code Detail JSON Logo

1346698941 NPI number — PENNY SUE WALLMAN

NPI Number: 1346698941
Health Care Provider/Practitioner: PENNY SUE WALLMAN

Information about “1346698941” NPI (PENNY SUE WALLMAN) exists in 1346698941 in HTML format HTML  |  1346698941 in plain Text format TXT  |  1346698941 in PDF (Portable Document Format) PDF  |  1346698941 in an XML format XML  formats.

NPI Number : 1346698941 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346698941",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALLMAN",
    "FirstName": "PENNY",
    "MiddleName": "SUE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "677 E MAIN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CENTREVILLE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49032-8524",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "269-467-1000",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "735 E CHICAGO ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BRONSON",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49028-1349",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "517-858-1400",
    "PracticeLocationAddressFaxNumber": "517-858-1403",
    "EnumerationDate": "05/25/2016",
    "LastUpdateDate": "02/02/2024",
    "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": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "4704167228",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "28167664A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP2300X",
          "TaxonomyName": "Primary Care Nurse Practitioner",
          "LicenseNumber": "4704167228",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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