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1346709557 NPI number — DEVIN L WENGERT PNP

NPI Number: 1346709557
Health Care Provider/Practitioner: DEVIN L WENGERT PNP

Information about “1346709557” NPI (DEVIN L WENGERT PNP) exists in 1346709557 in HTML format HTML  |  1346709557 in plain Text format TXT  |  1346709557 in PDF (Portable Document Format) PDF  |  1346709557 in an XML format XML  formats.

NPI Number : 1346709557 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346709557",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WENGERT",
    "FirstName": "DEVIN",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 17749",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TUCSON",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85731-7749",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "520-618-8810",
    "MailingAddressFaxNumber": "520-618-8847",
    "FirstLinePracticeLocationAddress": "5055 E BROADWAY BLVD STE A200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TUCSON",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85711-3649",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "520-818-8810",
    "PracticeLocationAddressFaxNumber": "520-818-8847",
    "EnumerationDate": "03/18/2019",
    "LastUpdateDate": "01/15/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": "223219",
        "LicenseNumberStateCode": "AZ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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