NPI Code Detail JSON Logo

1043462690 NPI number — SUSAN LYNETTE LYON NURSE PRACTITIONER

NPI Number: 1043462690
Health Care Provider/Practitioner: SUSAN LYNETTE LYON NURSE PRACTITIONER

Information about “1043462690” NPI (SUSAN LYNETTE LYON NURSE PRACTITIONER) exists in 1043462690 in HTML format HTML  |  1043462690 in plain Text format TXT  |  1043462690 in PDF (Portable Document Format) PDF  |  1043462690 in an XML format XML  formats.

NPI Number : 1043462690 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043462690",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LYON",
    "FirstName": "SUSAN",
    "MiddleName": "LYNETTE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "NURSE PRACTITIONER",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LYON",
    "OtherFirstName": "LYNETTE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "10440 BLACK MOUNTAIN RD.",
    "SecondLineMailingAddress": "SAN DIEGO MIRAMAR COLLEGE, STUDENT HEALTH SERVICES S103",
    "MailingAddressCityName": "SAN DIEGO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92126",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "858-536-7881",
    "MailingAddressFaxNumber": "858-689-0387",
    "FirstLinePracticeLocationAddress": "10440 BLACK MOUNTAIN RD",
    "SecondLinePracticeLocationAddress": "SAN DIEGO MIRAMAR COLLEGE STUDENT HEALTH SERVICES S-103",
    "PracticeLocationAddressCityName": "SAN DIEGO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92126",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "858-536-7881",
    "PracticeLocationAddressFaxNumber": "858-689-0387",
    "EnumerationDate": "10/15/2008",
    "LastUpdateDate": "10/15/2008",
    "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": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "11463",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "403159",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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