Active NPI
Johnette B. Wilson III, R.T.
- Radiologic Technologist
- Oakland, CA
National Provider Identifier
1285898809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiologic Technologist
- License
- 44981
- Practice address
- 2923 75TH Ave
Oakland, CA 94605-2903 - Phone
- (415) 571-0542
- NPI assigned
- Jul 13, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiologic Technologist | 247100000X | 44981 | CA | Primary |
| Radiologic Technologist | 247100000X | 176908 | CA |
Addresses
Primary practice location
2923 75TH Ave
Oakland, CA 94605-2903
Mailing address
2923 75TH Ave
PO Box 5056
Oakland, CA 94605-2903
Phone (415) 571-0542
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 |
|---|---|---|---|
| 176908 | CA | MD | Radiologic Technologist |
| 44981 | CA | MD | Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215907200000",
"number": "1285898809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2923 75TH AVE",
"address_2": "PO BOX 5056",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946052903",
"telephone_number": "415-571-0542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2923 75TH AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946052903",
"telephone_number": "415-571-0542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JOHNETTE",
"middle_name": "B.",
"name_suffix": "III",
"credential": "R.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-13",
"last_updated": "2008-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "247100000X",
"taxonomy_group": "",
"desc": "Radiologic Technologist",
"state": "CA",
"license": "44981",
"primary": true
},
{
"code": "247100000X",
"taxonomy_group": "",
"desc": "Radiologic Technologist",
"state": "CA",
"license": "176908",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.