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1487569109 NPI number — DANA MARIE WILSON CSFA

NPI Number: 1487569109
Health Care Provider/Practitioner: DANA MARIE WILSON CSFA

Information about “1487569109” NPI (DANA MARIE WILSON CSFA) exists in 1487569109 in HTML format HTML  |  1487569109 in plain Text format TXT  |  1487569109 in PDF (Portable Document Format) PDF  |  1487569109 in an XML format XML  formats.

NPI Number : 1487569109 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487569109",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILSON",
    "FirstName": "DANA",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CSFA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GOERGEN",
    "OtherFirstName": "DANA",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "712 N MONROE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SANDPOINT",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83864-2114",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-627-7437",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8552 N GOVERNMENT WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HAYDEN",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83835-9280",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-772-2600",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/17/2026",
    "LastUpdateDate": "08/17/2026",
    "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": "246ZC0007X",
        "TaxonomyName": "Surgical Assistant",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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