NPI Code Detail JSON Logo

1104279215 NPI number — ASHLEY ELIZABETH CRUMB NURSE PRACTITIONER

NPI Number: 1104279215
Health Care Provider/Practitioner: ASHLEY ELIZABETH CRUMB NURSE PRACTITIONER

Information about “1104279215” NPI (ASHLEY ELIZABETH CRUMB NURSE PRACTITIONER) exists in 1104279215 in HTML format HTML  |  1104279215 in plain Text format TXT  |  1104279215 in PDF (Portable Document Format) PDF  |  1104279215 in an XML format XML  formats.

NPI Number : 1104279215 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104279215",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CRUMB",
    "FirstName": "ASHLEY",
    "MiddleName": "ELIZABETH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NURSE PRACTITIONER",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "930 S SALINA ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SYRACUSE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "13202-3530",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "315-453-4453",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "900 S GEDDES ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SYRACUSE",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "13204-3837",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "315-572-1663",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/14/2016",
    "LastUpdateDate": "12/03/2024",
    "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": "163WM0705X",
          "TaxonomyName": "Medical-Surgical Registered Nurse",
          "LicenseNumber": "683370",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "F344477-1",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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