NPI Code Detail JSON Logo

1134504103 NPI number — ROSS ALAN VANNORMAN PAC

NPI Number: 1134504103
Health Care Provider/Practitioner: ROSS ALAN VANNORMAN PAC

Information about “1134504103” NPI (ROSS ALAN VANNORMAN PAC) exists in 1134504103 in HTML format HTML  |  1134504103 in plain Text format TXT  |  1134504103 in PDF (Portable Document Format) PDF  |  1134504103 in an XML format XML  formats.

NPI Number : 1134504103 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134504103",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VANNORMAN",
    "FirstName": "ROSS",
    "MiddleName": "ALAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "700 NE 87TH AVE STE 220240",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VANCOUVER",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98664-1913",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-882-2778",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "700 NE 87TH AVE STE 220240",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VANCOUVER",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98664-4896",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-882-2778",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/20/2015",
    "LastUpdateDate": "03/06/2025",
    "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": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "PA172769",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "PA60999792",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.