1114537222 NPI number — NATALIE JOAN WILSON CPNP

Table of content: EVANGELINA F LOPEZ AMFT (NPI 1407988447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114537222 NPI number — NATALIE JOAN WILSON CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
NATALIE
Provider Middle Name:
JOAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114537222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1463 US HIGHWAY 61 STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FESTUS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63028-4160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-596-6541
Provider Business Mailing Address Fax Number:
636-933-2190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1463 US HWY 61
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
FESTUS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63028-6302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-596-6541
Provider Business Practice Location Address Fax Number:
636-933-2910
Provider Enumeration Date:
08/04/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  2020010590 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2013015912 . This is a "RN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2020010590 . This is a "PNCB CERTIFICATION NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com