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1679042790 NPI number — PATTY R. WILSON CRNP-PMH, PHD

NPI Number: 1679042790
Health Care Provider/Practitioner: PATTY R. WILSON CRNP-PMH, PHD

Information about “1679042790” NPI (PATTY R. WILSON CRNP-PMH, PHD) exists in 1679042790 in HTML format HTML  |  1679042790 in plain Text format TXT  |  1679042790 in PDF (Portable Document Format) PDF  |  1679042790 in an XML format XML  formats.

NPI Number : 1679042790 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679042790",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILSON",
    "FirstName": "PATTY",
    "MiddleName": "R.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRNP-PMH, PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "525 N WOLFE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BALTIMORE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21205-2110",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "410-929-0104",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "800 N CHARLES ST STE 4R",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BALTIMORE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21201-5318",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "240-304-3327",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/19/2018",
    "LastUpdateDate": "01/11/2024",
    "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": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": "R122302",
        "LicenseNumberStateCode": "MD",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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