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1477714939 NPI number — CHRISTINE MARIE VANDER WIELEN MSW

NPI Number: 1477714939
Health Care Provider/Practitioner: CHRISTINE MARIE VANDER WIELEN MSW

Information about “1477714939” NPI (CHRISTINE MARIE VANDER WIELEN MSW) exists in 1477714939 in HTML format HTML  |  1477714939 in plain Text format TXT  |  1477714939 in PDF (Portable Document Format) PDF  |  1477714939 in an XML format XML  formats.

NPI Number : 1477714939 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477714939",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VANDER WIELEN",
    "FirstName": "CHRISTINE",
    "MiddleName": "MARIE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "MSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1476 KENWOOD CTR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MENASHA",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54952-1134",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "920-720-8872",
    "MailingAddressFaxNumber": "920-720-8873",
    "FirstLinePracticeLocationAddress": "1476 KENWOOD CTR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MENASHA",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54952-1134",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "920-720-8872",
    "PracticeLocationAddressFaxNumber": "920-720-8873",
    "EnumerationDate": "06/18/2008",
    "LastUpdateDate": "03/21/2012",
    "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": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "1453-121",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "7710-123",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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