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1033675004 NPI number — TRUMON OTTO CRAFT IV MSN, A-GNP

NPI Number: 1033675004
Health Care Provider/Practitioner: TRUMON OTTO CRAFT IV MSN, A-GNP

Information about “1033675004” NPI (TRUMON OTTO CRAFT IV MSN, A-GNP) exists in 1033675004 in HTML format HTML  |  1033675004 in plain Text format TXT  |  1033675004 in PDF (Portable Document Format) PDF  |  1033675004 in an XML format XML  formats.

NPI Number : 1033675004 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033675004",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CRAFT",
    "FirstName": "TRUMON",
    "MiddleName": "OTTO",
    "NamePrefix": null,
    "NameSuffix": "IV",
    "Credential": "MSN, A-GNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "220 EAST AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIFLE",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "81650-2332",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "970-625-5521",
    "MailingAddressFaxNumber": "970-625-9336",
    "FirstLinePracticeLocationAddress": "220 EAST AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIFLE",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "81650-2332",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "970-625-5521",
    "PracticeLocationAddressFaxNumber": "970-625-9336",
    "EnumerationDate": "02/14/2019",
    "LastUpdateDate": "06/28/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LA2200X",
          "TaxonomyName": "Adult Health Nurse Practitioner",
          "LicenseNumber": "0995336-NP",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163WC0200X",
          "TaxonomyName": "Critical Care Medicine Registered Nurse",
          "LicenseNumber": "RN.0169891",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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