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1518181916 NPI number — CANDACE JOANN WILDER PTA

NPI Number: 1518181916
Health Care Provider/Practitioner: CANDACE JOANN WILDER PTA

Information about “1518181916” NPI (CANDACE JOANN WILDER PTA) exists in 1518181916 in HTML format HTML  |  1518181916 in plain Text format TXT  |  1518181916 in PDF (Portable Document Format) PDF  |  1518181916 in an XML format XML  formats.

NPI Number : 1518181916 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1518181916",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILDER",
    "FirstName": "CANDACE",
    "MiddleName": "JOANN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PTA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "214 W DURHAM PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BROKEN ARROW",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "74011-3457",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "918-455-5429",
    "MailingAddressFaxNumber": "918-687-4092",
    "FirstLinePracticeLocationAddress": "3310 CHANDLER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MUSKOGEE",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "74403-4906",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "918-686-0646",
    "PracticeLocationAddressFaxNumber": "918-687-4092",
    "EnumerationDate": "04/13/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "225200000X",
        "TaxonomyName": "Physical Therapy Assistant",
        "LicenseNumber": "PTA532",
        "LicenseNumberStateCode": "OK",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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