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1396413936 NPI number — GWENDOLYN DAWN EVANS NP

NPI Number: 1396413936
Health Care Provider/Practitioner: GWENDOLYN DAWN EVANS NP

Information about “1396413936” NPI (GWENDOLYN DAWN EVANS NP) exists in 1396413936 in HTML format HTML  |  1396413936 in plain Text format TXT  |  1396413936 in PDF (Portable Document Format) PDF  |  1396413936 in an XML format XML  formats.

NPI Number : 1396413936 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396413936",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EVANS",
    "FirstName": "GWENDOLYN",
    "MiddleName": "DAWN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 388",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FISHERSVILLE",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22939-0388",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "540-332-5168",
    "MailingAddressFaxNumber": "540-332-5875",
    "FirstLinePracticeLocationAddress": "201 LEW DEWITT BLVD STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WAYNESBORO",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22980-1663",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "540-245-7940",
    "PracticeLocationAddressFaxNumber": "540-245-7941",
    "EnumerationDate": "08/30/2021",
    "LastUpdateDate": "02/26/2025",
    "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": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "4704352470NSA210NL",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "0024192192",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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