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1740584218 NPI number — EMAN'ON FEARLESS WANDERER

NPI Number: 1740584218
Health Care Provider/Practitioner: EMAN'ON FEARLESS WANDERER

Information about “1740584218” NPI (EMAN'ON FEARLESS WANDERER) exists in 1740584218 in HTML format HTML  |  1740584218 in plain Text format TXT  |  1740584218 in PDF (Portable Document Format) PDF  |  1740584218 in an XML format XML  formats.

NPI Number : 1740584218 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740584218",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WANDERER",
    "FirstName": "EMAN'ON",
    "MiddleName": "FEARLESS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SCOTT",
    "OtherFirstName": "NATHANIEL",
    "OtherMiddleName": "CORNELIUS",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 1841",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MAKAWAO",
    "MailingAddressStateName": "HI",
    "MailingAddressPostalCode": "96768-1841",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "808-283-3016",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1390 MILLER ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HONOLULU",
    "PracticeLocationAddressStateName": "HI",
    "PracticeLocationAddressPostalCode": "96813-2493",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "808-784-6200",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/27/2010",
    "LastUpdateDate": "11/20/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "172V00000X",
          "TaxonomyName": "Community Health Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "HI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0801X",
          "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
          "LicenseNumber": "171M00000X",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106S00000X",
          "TaxonomyName": "Behavior Technician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "HI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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