NPI Record of JENNIFER AKIKO WANBERG MS, RD, LD, ACE-CPT NPI 1003417841

Dietitian, Registered in Columbus, MT

Complete NPI Record

Field Name Value Definition
NPI1003417841The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code1Code 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 Last Name Legal NameWANBERGThe last name of the provider. If the provider is an individual, this is the legal name.
Provider First NameJENNIFERThe first name of the provider, if the provider is an individual.
Provider Middle NameAKIKOThe middle name of the provider, if the provider is an individual.
Provider Credential TextMS, RD, LD, ACE-CPTThe abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address50 COTTONWOOD SPRINGS RDThe 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 NameCOLUMBUSThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameMTThe 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 Code590197483The 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 Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number7202569843The 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’’.
Provider First Line Business Practice Location Address50 COTTONWOOD SPRINGS RDThe 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 NameCOLUMBUSThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMTThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code590197483The 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 Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number7202569843The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date11/6/2020The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date9/7/2021The date that a record was last updated or changed.
Provider Gender CodeFThe code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1133V00000XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 13227TThe license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1ALThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1Y
Is Sole ProprietorYCode indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date9/7/2021