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1497816664 NPI number — WANDA E PALENA DMD

NPI Number: 1497816664
Health Care Provider/Practitioner: WANDA E PALENA DMD

Information about “1497816664” NPI (WANDA E PALENA DMD) exists in 1497816664 in HTML format HTML  |  1497816664 in plain Text format TXT  |  1497816664 in PDF (Portable Document Format) PDF  |  1497816664 in an XML format XML  formats.

NPI Number : 1497816664 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497816664",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PALENA",
    "FirstName": "WANDA",
    "MiddleName": "E",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2602 NW 126TH STREET",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VANCOUVER",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98685",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-574-0495",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2415 NE 134TH ST",
    "SecondLinePracticeLocationAddress": "SUITE 307",
    "PracticeLocationAddressCityName": "VANCOUVER",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98686-3025",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-567-3333",
    "PracticeLocationAddressFaxNumber": "360-567-0728",
    "EnumerationDate": "12/12/2006",
    "LastUpdateDate": "07/13/2009",
    "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": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": "DE00007668",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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