{
"Npi": {
"NPI": "1629362207",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WHEELER",
"FirstName": "SAMANTHA",
"MiddleName": "MARIE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WALTERS",
"OtherFirstName": "SAMANTHA",
"OtherMiddleName": "MARIE",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "PA-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "500 SW 7TH ST STE A205",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RENTON",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98057-2983",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "877-522-1275",
"MailingAddressFaxNumber": "833-888-7145",
"FirstLinePracticeLocationAddress": "1630 23RD AVE STE 501",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LEWISTON",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83501-6345",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "877-522-1275",
"PracticeLocationAddressFaxNumber": "833-888-7145",
"EnumerationDate": "06/01/2011",
"LastUpdateDate": "03/06/2025",
"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": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}