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1083006522 NPI number — SHANNON ELOISE BOLT ARNP

NPI Number: 1083006522
Health Care Provider/Practitioner: SHANNON ELOISE BOLT ARNP

Information about “1083006522” NPI (SHANNON ELOISE BOLT ARNP) exists in 1083006522 in HTML format HTML  |  1083006522 in plain Text format TXT  |  1083006522 in PDF (Portable Document Format) PDF  |  1083006522 in an XML format XML  formats.

NPI Number : 1083006522 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083006522",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOLT",
    "FirstName": "SHANNON",
    "MiddleName": "ELOISE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ARNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "REIS",
    "OtherFirstName": "SHANNON",
    "OtherMiddleName": "ELOISE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4209 TIETON DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "YAKIMA",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98908-3377",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "509-654-9810",
    "MailingAddressFaxNumber": "509-966-8812",
    "FirstLinePracticeLocationAddress": "4209 TIETON DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "YAKIMA",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98908-3377",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "509-654-9810",
    "PracticeLocationAddressFaxNumber": "509-966-8812",
    "EnumerationDate": "02/20/2015",
    "LastUpdateDate": "11/21/2022",
    "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": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "RN60528267",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "AP61369683",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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