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1598573776 NPI number — SHANICE WILSON NP

NPI Number: 1598573776
Health Care Provider/Practitioner: SHANICE WILSON NP

Information about “1598573776” NPI (SHANICE WILSON NP) exists in 1598573776 in HTML format HTML  |  1598573776 in plain Text format TXT  |  1598573776 in PDF (Portable Document Format) PDF  |  1598573776 in an XML format XML  formats.

NPI Number : 1598573776 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598573776",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILSON",
    "FirstName": "SHANICE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5792 MAIN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WILLIAMSVILLE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "14221-5702",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "716-923-4380",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4979 HARLEM RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AMHERST",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "14226-2547",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "716-923-4381",
    "PracticeLocationAddressFaxNumber": "716-923-4384",
    "EnumerationDate": "12/20/2024",
    "LastUpdateDate": "01/31/2025",
    "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": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "713224",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LA2200X",
          "TaxonomyName": "Adult Health Nurse Practitioner",
          "LicenseNumber": "312163",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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