NPI Code Detail JSON Logo

1053697888 NPI number — VICKIE JEAN CAMILLI CRNA

NPI Number: 1053697888
Health Care Provider/Practitioner: VICKIE JEAN CAMILLI CRNA

Information about “1053697888” NPI (VICKIE JEAN CAMILLI CRNA) exists in 1053697888 in HTML format HTML  |  1053697888 in plain Text format TXT  |  1053697888 in PDF (Portable Document Format) PDF  |  1053697888 in an XML format XML  formats.

NPI Number : 1053697888 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053697888",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CAMILLI",
    "FirstName": "VICKIE",
    "MiddleName": "JEAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRNA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1735 27TH ST STE B06",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORTSMOUTH",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45662-2681",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "740-356-8681",
    "MailingAddressFaxNumber": "740-356-1256",
    "FirstLinePracticeLocationAddress": "1805 27TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORTSMOUTH",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45662-2686",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "740-356-8231",
    "PracticeLocationAddressFaxNumber": "740-356-3686",
    "EnumerationDate": "10/25/2011",
    "LastUpdateDate": "09/24/2024",
    "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": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "084528",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "APRN.CRNA.0020937",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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