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1114680709 NPI number — SHANNON CONNOR JUNIOR CRNA, APN

NPI Number: 1114680709
Health Care Provider/Practitioner: SHANNON CONNOR JUNIOR CRNA, APN

Information about “1114680709” NPI (SHANNON CONNOR JUNIOR CRNA, APN) exists in 1114680709 in HTML format HTML  |  1114680709 in plain Text format TXT  |  1114680709 in PDF (Portable Document Format) PDF  |  1114680709 in an XML format XML  formats.

NPI Number : 1114680709 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114680709",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JUNIOR",
    "FirstName": "SHANNON",
    "MiddleName": "CONNOR",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": "CRNA, APN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JUNIOR",
    "OtherFirstName": "SHANNON",
    "OtherMiddleName": "CONNOR",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "658 N SARATOGA DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MOORESTOWN",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08057-3834",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "856-313-3798",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1600 HADDON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CAMDEN",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08103-3101",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "856-755-1616",
    "PracticeLocationAddressFaxNumber": "856-755-0098",
    "EnumerationDate": "10/20/2021",
    "LastUpdateDate": "10/20/2021",
    "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": "367500000X",
        "TaxonomyName": "Certified Registered Nurse Anesthetist",
        "LicenseNumber": "26NJ01217800",
        "LicenseNumberStateCode": "NJ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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