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1033146725 NPI number — EVA MAE HENDERSON M.D.

NPI Number: 1033146725
Health Care Provider/Practitioner: EVA MAE HENDERSON M.D.

Information about “1033146725” NPI (EVA MAE HENDERSON M.D.) exists in 1033146725 in HTML format HTML  |  1033146725 in plain Text format TXT  |  1033146725 in PDF (Portable Document Format) PDF  |  1033146725 in an XML format XML  formats.

NPI Number : 1033146725 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033146725",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HENDERSON",
    "FirstName": "EVA",
    "MiddleName": "MAE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CAMARA",
    "OtherFirstName": "EVA",
    "OtherMiddleName": "HENDERSON",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.D.",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "PO BOX 3437",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSON",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "39207-3437",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "601-362-5321",
    "MailingAddressFaxNumber": "601-354-5159",
    "FirstLinePracticeLocationAddress": "350 W WOODROW WILSON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSON",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39213-7681",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "601-709-5150",
    "PracticeLocationAddressFaxNumber": "601-709-5151",
    "EnumerationDate": "06/27/2006",
    "LastUpdateDate": "06/06/2011",
    "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": "208000000X",
        "TaxonomyName": "Pediatrics Physician",
        "LicenseNumber": "10119",
        "LicenseNumberStateCode": "MS",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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