NPI Code Detail JSON Logo

1063032829 NPI number — MARIAH ANN STEPHENSON

NPI Number: 1063032829
Health Care Provider/Practitioner: MARIAH ANN STEPHENSON

Information about “1063032829” NPI (MARIAH ANN STEPHENSON) exists in 1063032829 in HTML format HTML  |  1063032829 in plain Text format TXT  |  1063032829 in PDF (Portable Document Format) PDF  |  1063032829 in an XML format XML  formats.

NPI Number : 1063032829 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063032829",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "STEPHENSON",
    "FirstName": "MARIAH",
    "MiddleName": "ANN",
    "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": "15137 DANVILLE AVE W",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROSEMOUNT",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55068",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3900 BETHEL DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT PAUL",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55112-6902",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-315-3688",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/22/2020",
    "LastUpdateDate": "06/28/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "05/28/2020",
    "NPIReactivationDate": "06/28/2021",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "390200000X",
        "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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