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1154650117 NPI number — PENELOPE MASHBURN D.O.

NPI Number: 1154650117
Health Care Provider/Practitioner: PENELOPE MASHBURN D.O.

Information about “1154650117” NPI (PENELOPE MASHBURN D.O.) exists in 1154650117 in HTML format HTML  |  1154650117 in plain Text format TXT  |  1154650117 in PDF (Portable Document Format) PDF  |  1154650117 in an XML format XML  formats.

NPI Number : 1154650117 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154650117",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MASHBURN",
    "FirstName": "PENELOPE",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "D.O.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PAREDES",
    "OtherFirstName": "PENELOPE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "D.O.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2200 JEFFERSON AVE",
    "SecondLineMailingAddress": "4TH FLOOR",
    "MailingAddressCityName": "TOLEDO",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "43604-7101",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "27 ST. LAWRENCE DR.",
    "SecondLinePracticeLocationAddress": "SUITE203",
    "PracticeLocationAddressCityName": "TIFFIN",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44883",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "305-575-9978",
    "PracticeLocationAddressFaxNumber": "419-455-8564",
    "EnumerationDate": "12/21/2009",
    "LastUpdateDate": "09/29/2014",
    "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": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "34.011231",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": "P12-00612",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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