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1629694690 NPI number — BRITNE LYNN WAKEM PHARMD

NPI Number: 1629694690
Health Care Provider/Practitioner: BRITNE LYNN WAKEM PHARMD

Information about “1629694690” NPI (BRITNE LYNN WAKEM PHARMD) exists in 1629694690 in HTML format HTML  |  1629694690 in plain Text format TXT  |  1629694690 in PDF (Portable Document Format) PDF  |  1629694690 in an XML format XML  formats.

NPI Number : 1629694690 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629694690",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WAKEM",
    "FirstName": "BRITNE",
    "MiddleName": "LYNN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WAKEM",
    "OtherFirstName": "BRITNE",
    "OtherMiddleName": "LYNN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "KLUPENGER",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4709 BLACKBERRY CT SE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LACEY",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98503-5984",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-250-3633",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "110 W K ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SHELTON",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98584-2944",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-545-4333",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/24/2020",
    "LastUpdateDate": "06/24/2020",
    "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": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "PH60574901",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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