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1023362092 NPI number — JENNIFER MARIE BEAVER RN

NPI Number: 1023362092
Health Care Provider/Practitioner: JENNIFER MARIE BEAVER RN

Information about “1023362092” NPI (JENNIFER MARIE BEAVER RN) exists in 1023362092 in HTML format HTML  |  1023362092 in plain Text format TXT  |  1023362092 in PDF (Portable Document Format) PDF  |  1023362092 in an XML format XML  formats.

NPI Number : 1023362092 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023362092",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BEAVER",
    "FirstName": "JENNIFER",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BICKLE",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "RN",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "HCR 61 BOX 30",
    "SecondLineMailingAddress": "FOUR CORNERS REGIONAL HEALTH CENTER",
    "MailingAddressCityName": "TEEC NOS POS",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "86514",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "928-656-5000",
    "MailingAddressFaxNumber": "928-656-5164",
    "FirstLinePracticeLocationAddress": "JCT. HWY 160 & NAVAJO ROUTE 35 - RED MESA",
    "SecondLinePracticeLocationAddress": "FOUR CORNERS REGIONAL HEALTH CENTER",
    "PracticeLocationAddressCityName": "TEEC NOS POS",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "86514",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "928-656-5000",
    "PracticeLocationAddressFaxNumber": "928-656-5164",
    "EnumerationDate": "10/30/2012",
    "LastUpdateDate": "10/30/2012",
    "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": "163WP2201X",
        "TaxonomyName": "Ambulatory Care Registered Nurse",
        "LicenseNumber": "RN 9273066",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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