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1053110825 NPI number — BRANDON LEE MASS BA

NPI Number: 1053110825
Health Care Provider/Practitioner: BRANDON LEE MASS BA

Information about “1053110825” NPI (BRANDON LEE MASS BA) exists in 1053110825 in HTML format HTML  |  1053110825 in plain Text format TXT  |  1053110825 in PDF (Portable Document Format) PDF  |  1053110825 in an XML format XML  formats.

NPI Number : 1053110825 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053110825",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MASS",
    "FirstName": "BRANDON",
    "MiddleName": "LEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "BA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1941 S 42ND ST STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OMAHA",
    "MailingAddressStateName": "NE",
    "MailingAddressPostalCode": "68105-2939",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "402-346-5220",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1941 S 42ND ST STE 122",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OMAHA",
    "PracticeLocationAddressStateName": "NE",
    "PracticeLocationAddressPostalCode": "68105-2942",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "402-346-5220",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/12/2025",
    "LastUpdateDate": "03/12/2025",
    "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": "373H00000X",
          "TaxonomyName": "Day Training/Habilitation Specialist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "373H00000X",
          "TaxonomyName": "Day Training/Habilitation Specialist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "NE",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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