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1083747596 NPI number — SHELLI ELYSE PRUGER M.A.

NPI Number: 1083747596
Health Care Provider/Practitioner: SHELLI ELYSE PRUGER M.A.

Information about “1083747596” NPI (SHELLI ELYSE PRUGER M.A.) exists in 1083747596 in HTML format HTML  |  1083747596 in plain Text format TXT  |  1083747596 in PDF (Portable Document Format) PDF  |  1083747596 in an XML format XML  formats.

NPI Number : 1083747596 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083747596",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PRUGER",
    "FirstName": "SHELLI",
    "MiddleName": "ELYSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.A.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "RABINOVITZ",
    "OtherFirstName": "SHELLI",
    "OtherMiddleName": "ELYSE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2301 MARSHALL WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SACRAMENTO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95818-3547",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "916-317-4467",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5030 EL CAMINO AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CARMICHAEL",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95608-4650",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "916-609-5100",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/13/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "171M00000X",
        "TaxonomyName": "Case Manager/Care Coordinator",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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