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1154119808 NPI number — KHORIASA MARIE RUFFELL LPN

NPI Number: 1154119808
Health Care Provider/Practitioner: KHORIASA MARIE RUFFELL LPN

Information about “1154119808” NPI (KHORIASA MARIE RUFFELL LPN) exists in 1154119808 in HTML format HTML  |  1154119808 in plain Text format TXT  |  1154119808 in PDF (Portable Document Format) PDF  |  1154119808 in an XML format XML  formats.

NPI Number : 1154119808 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154119808",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RUFFELL",
    "FirstName": "KHORIASA",
    "MiddleName": "MARIE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LPN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BLACK",
    "OtherFirstName": "KHORIASA",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "LPN",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "15 SUFFERN PL STE A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SUFFERN",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10901-5566",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6 WALNUT DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PLEASANT VALLEY",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "12569-6934",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "845-366-9212",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/30/2025",
    "LastUpdateDate": "04/30/2025",
    "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": "164W00000X",
        "TaxonomyName": "Licensed Practical Nurse",
        "LicenseNumber": "332724-01",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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