1629057849 NPI number — ELIZABETH WELDER WAGNER L.I.S.W.

NPI Number: 1629057849
Health Care Provider/Practitioner: ELIZABETH WELDER WAGNER L.I.S.W.

NPI Number : 1629057849 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629057849",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "X",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WAGNER",
    "FirstName": "ELIZABETH",
    "MiddleName": "WELDER",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "L.I.S.W.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WELDER",
    "OtherFirstName": "ELIZABETH",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "L.I.S.W.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1217 K AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEVADA",
    "MailingAddressStateName": "IA",
    "MailingAddressPostalCode": "50201-1943",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "515-382-4099",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3600 LINCOLN WAY",
    "SecondLinePracticeLocationAddress": "SUITE 4",
    "PracticeLocationAddressCityName": "AMES",
    "PracticeLocationAddressStateName": "IA",
    "PracticeLocationAddressPostalCode": "50014-7595",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "515-239-4410",
    "PracticeLocationAddressFaxNumber": "515-663-4885",
    "EnumerationDate": "01/16/2006",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "04701",
        "LicenseNumberStateCode": "IA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}