1003204835 NPI number — BRIANNA ALEXANDRIA HENDRA M.S., A.T., A.T.C.

NPI Number: 1003204835
Health Care Provider/Practitioner: BRIANNA ALEXANDRIA HENDRA M.S., A.T., A.T.C.

NPI Number : 1003204835 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003204835",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HENDRA",
    "FirstName": "BRIANNA",
    "MiddleName": "ALEXANDRIA",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.S., A.T., A.T.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "998 E FOREST AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "YPSILANTI",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48198-3877",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "661-753-6579",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "18601 MIDDLEBELT RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROMULUS",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48174-9290",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "661-753-6579",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/01/2015",
    "LastUpdateDate": "05/01/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "AT.004820",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "2601001390",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}