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1104644871 NPI number — CARSYN ROSE BOSWELL

NPI Number: 1104644871
Health Care Provider/Practitioner: CARSYN ROSE BOSWELL

Information about “1104644871” NPI (CARSYN ROSE BOSWELL) exists in 1104644871 in HTML format HTML  |  1104644871 in plain Text format TXT  |  1104644871 in PDF (Portable Document Format) PDF  |  1104644871 in an XML format XML  formats.

NPI Number : 1104644871 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104644871",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOSWELL",
    "FirstName": "CARSYN",
    "MiddleName": "ROSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5414 OLD CAVERN HWY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CARLSBAD",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "88220-9176",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-360-1494",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1111 MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WAYNE",
    "PracticeLocationAddressStateName": "NE",
    "PracticeLocationAddressPostalCode": "68787-1181",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "402-375-7321",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/01/2024",
    "LastUpdateDate": "10/01/2024",
    "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": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "513906498",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": "513906498",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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