{
"Npi": {
"NPI": "1659836914",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "VANDERWALL",
"FirstName": "AMY",
"MiddleName": "ELIZABETH",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "CRNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SINNER",
"OtherFirstName": "AMY",
"OtherMiddleName": "ELIZABETH",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "33 W 3RD ST STE 201",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WILLIAMSPORT",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17701-6523",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "570-429-3501",
"MailingAddressFaxNumber": "570-429-3502",
"FirstLinePracticeLocationAddress": "33 W 3RD ST STE 201",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WILLIAMSPORT",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "17701-6523",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "570-429-3501",
"PracticeLocationAddressFaxNumber": "570-429-3502",
"EnumerationDate": "01/31/2019",
"LastUpdateDate": "04/23/2025",
"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": "SP020400",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP2300X",
"TaxonomyName": "Primary Care Nurse Practitioner",
"LicenseNumber": "SP020400",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "RN630439",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}