NPI Code Detail JSON Logo

1154030401 NPI number — MISTY MARIE CRICK-GOODMAN LE

NPI Number: 1154030401
Health Care Provider/Practitioner: MISTY MARIE CRICK-GOODMAN LE

Information about “1154030401” NPI (MISTY MARIE CRICK-GOODMAN LE) exists in 1154030401 in HTML format HTML  |  1154030401 in plain Text format TXT  |  1154030401 in PDF (Portable Document Format) PDF  |  1154030401 in an XML format XML  formats.

NPI Number : 1154030401 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154030401",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CRICK-GOODMAN",
    "FirstName": "MISTY",
    "MiddleName": "MARIE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LE",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "20622 108TH STREET CT E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BONNEY LAKE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98391-7969",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "253-332-3173",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "20622 108TH STREET CT E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BONNEY LAKE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98391-7969",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "253-332-3173",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/15/2022",
    "LastUpdateDate": "11/15/2022",
    "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": "246Z00000X",
        "TaxonomyName": "Other Specialist/Technologist",
        "LicenseNumber": "9756",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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