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1023834124 NPI number — REBECCA SABRINA JACKSON CRPA

NPI Number: 1023834124
Health Care Provider/Practitioner: REBECCA SABRINA JACKSON CRPA

Information about “1023834124” NPI (REBECCA SABRINA JACKSON CRPA) exists in 1023834124 in HTML format HTML  |  1023834124 in plain Text format TXT  |  1023834124 in PDF (Portable Document Format) PDF  |  1023834124 in an XML format XML  formats.

NPI Number : 1023834124 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023834124",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSON",
    "FirstName": "REBECCA",
    "MiddleName": "SABRINA",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "CRPA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JACKSON",
    "OtherFirstName": "REBECCA",
    "OtherMiddleName": "SABRINA",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "100 KRAMER ST APT 3E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STATEN ISLAND",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10305-2549",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "347-277-1843",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "100 KRAMER ST APT 3E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STATEN ISLAND",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10305-2549",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "347-277-1843",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/23/2024",
    "LastUpdateDate": "11/23/2024",
    "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": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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