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1033352265 NPI number — MIRA EDGERTON NURSE PRACTITIONER

NPI Number: 1033352265
Health Care Provider/Practitioner: MIRA EDGERTON NURSE PRACTITIONER

Information about “1033352265” NPI (MIRA EDGERTON NURSE PRACTITIONER) exists in 1033352265 in HTML format HTML  |  1033352265 in plain Text format TXT  |  1033352265 in PDF (Portable Document Format) PDF  |  1033352265 in an XML format XML  formats.

NPI Number : 1033352265 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033352265",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EDGERTON",
    "FirstName": "MIRA",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "NURSE PRACTITIONER",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4397 STONEYCROFT DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OKEMOS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48864-2935",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "517-349-0737",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4397 STONEYCROFT DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OKEMOS",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48864-2935",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "517-349-0737",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/17/2009",
    "LastUpdateDate": "01/21/2014",
    "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": "364SF0001X",
        "TaxonomyName": "Family Health Clinical Nurse Specialist",
        "LicenseNumber": "4704092938",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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