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1073880621 NPI number — MARIKO LEE ODHNER

NPI Number: 1073880621
Health Care Provider/Practitioner: MARIKO LEE ODHNER

Information about “1073880621” NPI (MARIKO LEE ODHNER) exists in 1073880621 in HTML format HTML  |  1073880621 in plain Text format TXT  |  1073880621 in PDF (Portable Document Format) PDF  |  1073880621 in an XML format XML  formats.

NPI Number : 1073880621 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073880621",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ODHNER",
    "FirstName": "MARIKO",
    "MiddleName": "LEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JAMESON",
    "OtherFirstName": "MARIKO",
    "OtherMiddleName": "LEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "325 MAIN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MEDFORD",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02155-6152",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "617-519-8246",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "269 UNION ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LYNN",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "01901-1314",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "781-596-2502",
    "PracticeLocationAddressFaxNumber": "781-596-3966",
    "EnumerationDate": "11/28/2011",
    "LastUpdateDate": "12/04/2015",
    "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": "NP37010",
          "LicenseNumberStateCode": "RI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "2268187",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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