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1619680436 NPI number — AMY JILL WIEDER

NPI Number: 1619680436
Health Care Provider/Practitioner: AMY JILL WIEDER

Information about “1619680436” NPI (AMY JILL WIEDER) exists in 1619680436 in HTML format HTML  |  1619680436 in plain Text format TXT  |  1619680436 in PDF (Portable Document Format) PDF  |  1619680436 in an XML format XML  formats.

NPI Number : 1619680436 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619680436",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WIEDER",
    "FirstName": "AMY",
    "MiddleName": "JILL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SQUYRES",
    "OtherFirstName": "AMY",
    "OtherMiddleName": "JILL",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "126 HOLLAND DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BUTLER",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "16002-7564",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "724-282-1627",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "901 E BRADY ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BUTLER",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "16001-4648",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "724-282-1627",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/27/2022",
    "LastUpdateDate": "12/27/2022",
    "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": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "PC015176",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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