NPI Code Detail JSON Logo

1053858621 NPI number — ALLISON RAE SHRACK

NPI Number: 1053858621
Health Care Provider/Practitioner: ALLISON RAE SHRACK

Information about “1053858621” NPI (ALLISON RAE SHRACK) exists in 1053858621 in HTML format HTML  |  1053858621 in plain Text format TXT  |  1053858621 in PDF (Portable Document Format) PDF  |  1053858621 in an XML format XML  formats.

NPI Number : 1053858621 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053858621",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHRACK",
    "FirstName": "ALLISON",
    "MiddleName": "RAE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2605 N LEBANON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LEBANON",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46052-1476",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "400 N MOUNT ZION RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LEBANON",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46052-9497",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "765-335-0123",
    "PracticeLocationAddressFaxNumber": "765-335-0127",
    "EnumerationDate": "01/20/2017",
    "LastUpdateDate": "04/24/2024",
    "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": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "28203711A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "71007355A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.