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1114582590 NPI number — GREGORY DAVID MIKUT ACNP

NPI Number: 1114582590
Health Care Provider/Practitioner: GREGORY DAVID MIKUT ACNP

Information about “1114582590” NPI (GREGORY DAVID MIKUT ACNP) exists in 1114582590 in HTML format HTML  |  1114582590 in plain Text format TXT  |  1114582590 in PDF (Portable Document Format) PDF  |  1114582590 in an XML format XML  formats.

NPI Number : 1114582590 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114582590",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MIKUT",
    "FirstName": "GREGORY",
    "MiddleName": "DAVID",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ACNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "12361 W BOLA DR STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SURPRISE",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85378-9021",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "602-641-9486",
    "MailingAddressFaxNumber": "480-500-8430",
    "FirstLinePracticeLocationAddress": "12361 W BOLA DR STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SURPRISE",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85378-9021",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "602-641-9486",
    "PracticeLocationAddressFaxNumber": "480-500-8430",
    "EnumerationDate": "05/01/2019",
    "LastUpdateDate": "10/21/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LA2100X",
        "TaxonomyName": "Acute Care Nurse Practitioner",
        "LicenseNumber": "RN169267",
        "LicenseNumberStateCode": "AZ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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