Active NPI
Wideline Etienne
- Licensed Practical Nurse
- Spring Valley, NY
National Provider Identifier
1730450255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 308873
- Practice address
- 17 Van Orden Ave
Apt. 2K
Spring Valley, NY 10977-5036 - Phone
- (845) 659-8487
- NPI assigned
- Jan 13, 2012
- Last updated
- Jan 13, 2012
- 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 | 308873 | NY | Primary |
Addresses
Primary practice location
17 Van Orden Ave
Apt. 2K
Spring Valley, NY 10977-5036
Mailing address
17 Van Orden Ave
Apt. 2K
Spring Valley, NY 10977-5036
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326412800000",
"number": "1730450255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 VAN ORDEN AVE",
"address_2": "APT. 2K",
"city": "SPRING VALLEY",
"state": "NY",
"postal_code": "109775036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 VAN ORDEN AVE",
"address_2": "APT. 2K",
"city": "SPRING VALLEY",
"state": "NY",
"postal_code": "109775036",
"telephone_number": "845-659-8487"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETIENNE",
"first_name": "WIDELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-13",
"last_updated": "2012-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "308873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spring Valley, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.