DAWN N WILDERMAN LPN, NPI 1568936482 — CHRISTOPHER (IL)

NPI 1568936482

1+ Years Experience Individual

DAWN N WILDERMAN LPN

01/14/2019
PROVIDER ENUMERATION DATE
01/14/2019
LAST UPDATE DATE
1568936482
NPI NUMBER

About DAWN N WILDERMAN

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

DAWN N WILDERMAN is a provider established in CHRISTOPHER, IL. The NPI number of DAWN N WILDERMAN is 1568936482 and was assigned on 01/14/2019. The practitioners primary taxonomy code is: 164W00000X with license number: 43080119 IL .

Mailing address

  • City: CHRISTOPHER
  • State: IL
  • Postal code: 628221037
  • Phone: 6187242401
  • Address: 4241 HIGHWAY 14 W

Primary Practice Address

  • Region : CHRISTOPHER, IL
  • NPI : 1568936482
  • Phone : 6187242401
  • Postalcode : 628221037
  • Address : 4241 HIGHWAY 14 W

Provider taxonomy - Licensed Practical Nurse

  • Taxonomy code: 164W00000X
  • License number: 43080119
  • License state: IL

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Contacts:

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  • DAWN N WILDERMAN LPN
  • Address : 4241 HIGHWAY 14 W
  • Region : CHRISTOPHER, IL
  • NPI : 1568936482
  • Phone : 6187242401
  • Postalcode : 628221037

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address4241 HIGHWAY 14 W
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCHRISTOPHER
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code628221037
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number6187242401
The telephone number associated with the location address of the provider being identified.
NPI1568936482
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1164W00000X
An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
Provider Enumeration Date01/14/2019
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated01/14/2019
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)DAWN N WILDERMAN
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address4241 HIGHWAY 14 W
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameCHRISTOPHER
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameIL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code628221037
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number6187242401
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Healthcare Provider Taxonomy Code #1164W00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Licensed Practical Nurse
An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
Provider License Number 143080119
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1IL
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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