NPI Code Detail JSON Logo

1124175161 NPI number — MARILYN MARIE CHAN EDD MSN MED APRN

NPI Number: 1124175161
Health Care Provider/Practitioner: MARILYN MARIE CHAN EDD MSN MED APRN

Information about “1124175161” NPI (MARILYN MARIE CHAN EDD MSN MED APRN) exists in 1124175161 in HTML format HTML  |  1124175161 in plain Text format TXT  |  1124175161 in PDF (Portable Document Format) PDF  |  1124175161 in an XML format XML  formats.

NPI Number : 1124175161 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124175161",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CHAN",
    "FirstName": "MARILYN",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "EDD MSN MED APRN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JONES",
    "OtherFirstName": "MARILYN",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3451 S EASTWOOD DRIVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALT LAKE CITY",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84109",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-272-2682",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8925 SOUTH 2700 WEST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WEST JORDAN",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84044",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-566-6200",
    "PracticeLocationAddressFaxNumber": "801-566-7993",
    "EnumerationDate": "01/04/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "363LP0200X",
        "TaxonomyName": "Pediatric Nurse Practitioner",
        "LicenseNumber": "87-199449-4405",
        "LicenseNumberStateCode": "UT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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