Active NPI
Wanda Lynn Sermon, LPN
- Licensed Practical Nurse
- Paterson, NJ
National Provider Identifier
1063100162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 26NP07315800
- Practice address
- 350 Preakness Ave
Paterson, NJ 07502-1757 - Phone
- (973) 595-1075
- NPI assigned
- Apr 26, 2023
- Last updated
- Apr 26, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 26NP07315800 | NJ | Primary |
Addresses
Primary practice location
350 Preakness Ave
Paterson, NJ 07502-1757
Mailing address
1266 Teaneck Rd Apt 8
Teaneck, NJ 07666-4947
Phone (917) 567-5989
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NP07315800 | NJ | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
350 Preakness Ave
Paterson, NJ 07502
Phone (973) 575-1075
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682467200000",
"number": "1063100162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1266 TEANECK RD APT 8",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076664947",
"telephone_number": "917-567-5989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 PREAKNESS AVE",
"city": "PATERSON",
"state": "NJ",
"postal_code": "075021757",
"telephone_number": "973-595-1075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERMON",
"first_name": "WANDA",
"middle_name": "LYNN",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-26",
"last_updated": "2023-04-26",
"certification_date": "2023-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NJ",
"license": "26NP07315800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paterson, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.