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1447726963 NPI number — MELISSA ADDIE WIEAND ATC

NPI Number: 1447726963
Health Care Provider/Practitioner: MELISSA ADDIE WIEAND ATC

Information about “1447726963” NPI (MELISSA ADDIE WIEAND ATC) exists in 1447726963 in HTML format HTML  |  1447726963 in plain Text format TXT  |  1447726963 in PDF (Portable Document Format) PDF  |  1447726963 in an XML format XML  formats.

NPI Number : 1447726963 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1447726963",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WIEAND",
    "FirstName": "MELISSA",
    "MiddleName": "ADDIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9 COLONIAL WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "INDIAN HARBOUR BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32937-4305",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "321-266-2115",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9 COLONIAL WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INDIAN HARBOUR BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32937-4305",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "321-266-2115",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/23/2018",
    "LastUpdateDate": "06/10/2025",
    "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": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "3097-39",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "AL6047",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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