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1053848309 NPI number — KIMBERLY MICHELLE MARINO DNP

NPI Number: 1053848309
Health Care Provider/Practitioner: KIMBERLY MICHELLE MARINO DNP

Information about “1053848309” NPI (KIMBERLY MICHELLE MARINO DNP) exists in 1053848309 in HTML format HTML  |  1053848309 in plain Text format TXT  |  1053848309 in PDF (Portable Document Format) PDF  |  1053848309 in an XML format XML  formats.

NPI Number : 1053848309 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053848309",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MARINO",
    "FirstName": "KIMBERLY",
    "MiddleName": "MICHELLE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MARINO",
    "OtherFirstName": "KIMBERLY",
    "OtherMiddleName": "MICHELLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "DNP",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "4302 APPLE TREE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TRAVERSE CITY",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49685-7401",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "231-492-7290",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "607 RANDOLPH ST STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TRAVERSE CITY",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49684-2248",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "231-251-1000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/17/2017",
    "LastUpdateDate": "05/09/2023",
    "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": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "4704214077",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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