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1851698674 NPI number — ZACHARY ANDREW WULBECKER

NPI Number: 1851698674
Health Care Provider/Practitioner: ZACHARY ANDREW WULBECKER

Information about “1851698674” NPI (ZACHARY ANDREW WULBECKER) exists in 1851698674 in HTML format HTML  |  1851698674 in plain Text format TXT  |  1851698674 in PDF (Portable Document Format) PDF  |  1851698674 in an XML format XML  formats.

NPI Number : 1851698674 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1851698674",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WULBECKER",
    "FirstName": "ZACHARY",
    "MiddleName": "ANDREW",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WULBECKER",
    "OtherFirstName": "ZACK",
    "OtherMiddleName": "ANDREW",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "PO BOX 118087",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NORTH CHARLESTON",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29423-8087",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "843-863-7462",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9200 UNIVERSITY BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORTH CHARLESTON",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29406-9121",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "438-637-4628",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/14/2011",
    "LastUpdateDate": "08/31/2020",
    "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": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA.0003686",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "1580",
          "LicenseNumberStateCode": "NE",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "3497",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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