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1104364470 NPI number — DIANE PERDUE FNP-C

NPI Number: 1104364470
Health Care Provider/Practitioner: DIANE PERDUE FNP-C

Information about “1104364470” NPI (DIANE PERDUE FNP-C) exists in 1104364470 in HTML format HTML  |  1104364470 in plain Text format TXT  |  1104364470 in PDF (Portable Document Format) PDF  |  1104364470 in an XML format XML  formats.

NPI Number : 1104364470 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104364470",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PERDUE",
    "FirstName": "DIANE",
    "MiddleName": null,
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "FNP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11548 LOCH LOMOND DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WHITTIER",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90606-1922",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "562-761-3626",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12400 BLOOMFIELD AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SANTA FE SPRINGS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90670-4750",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "562-789-5434",
    "PracticeLocationAddressFaxNumber": "562-863-1903",
    "EnumerationDate": "02/07/2017",
    "LastUpdateDate": "12/28/2018",
    "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": "697727",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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