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1093175523 NPI number — DOROTHY M PORTILLO FNP-C

NPI Number: 1093175523
Health Care Provider/Practitioner: DOROTHY M PORTILLO FNP-C

Information about “1093175523” NPI (DOROTHY M PORTILLO FNP-C) exists in 1093175523 in HTML format HTML  |  1093175523 in plain Text format TXT  |  1093175523 in PDF (Portable Document Format) PDF  |  1093175523 in an XML format XML  formats.

NPI Number : 1093175523 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093175523",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PORTILLO",
    "FirstName": "DOROTHY",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "FNP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PORTILLO",
    "OtherFirstName": "DOROTHY",
    "OtherMiddleName": "MARTINEZ",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "FNP-C",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "999 W AMADOR AVE STE D",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS CRUCES",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "88005-2739",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "575-527-5482",
    "MailingAddressFaxNumber": "575-525-3542",
    "FirstLinePracticeLocationAddress": "999 W AMADOR AVE STE D",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAS CRUCES",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "88005-2739",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "575-527-5482",
    "PracticeLocationAddressFaxNumber": "575-525-3542",
    "EnumerationDate": "02/25/2016",
    "LastUpdateDate": "05/12/2016",
    "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": "CNP-02857",
        "LicenseNumberStateCode": "NM",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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