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1114151214 NPI number — TINA E EVENSON CFNP

NPI Number: 1114151214
Health Care Provider/Practitioner: TINA E EVENSON CFNP

Information about “1114151214” NPI (TINA E EVENSON CFNP) exists in 1114151214 in HTML format HTML  |  1114151214 in plain Text format TXT  |  1114151214 in PDF (Portable Document Format) PDF  |  1114151214 in an XML format XML  formats.

NPI Number : 1114151214 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114151214",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EVENSON",
    "FirstName": "TINA",
    "MiddleName": "E",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CFNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KATNIS",
    "OtherFirstName": "TINA",
    "OtherMiddleName": "EILEEN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "439009 NORTHSIDE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKE CITY",
    "MailingAddressStateName": "SD",
    "MailingAddressPostalCode": "57247-6149",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "100 LAKE TRAVERSE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SISSETON",
    "PracticeLocationAddressStateName": "SD",
    "PracticeLocationAddressPostalCode": "57262-7046",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "605-698-7606",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/05/2009",
    "LastUpdateDate": "03/07/2022",
    "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": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "2009001820",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "R-130178-2",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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