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1164703328 NPI number — JOAN M COLLETT NP

NPI Number: 1164703328
Health Care Provider/Practitioner: JOAN M COLLETT NP

Information about “1164703328” NPI (JOAN M COLLETT NP) exists in 1164703328 in HTML format HTML  |  1164703328 in plain Text format TXT  |  1164703328 in PDF (Portable Document Format) PDF  |  1164703328 in an XML format XML  formats.

NPI Number : 1164703328 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164703328",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COLLETT",
    "FirstName": "JOAN",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2000 CIRCLE OF HOPE DR",
    "SecondLineMailingAddress": "ROOM N1550",
    "MailingAddressCityName": "SALT LAKE CITY",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84112-5550",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-213-4270",
    "MailingAddressFaxNumber": "801-585-7902",
    "FirstLinePracticeLocationAddress": "1055 N 500 W STE 202, BLDG C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PROVO",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84604-8460",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-374-2367",
    "PracticeLocationAddressFaxNumber": "801-429-8015",
    "EnumerationDate": "09/01/2011",
    "LastUpdateDate": "07/21/2022",
    "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": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "369162-4408",
          "LicenseNumberStateCode": "UT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LA2200X",
          "TaxonomyName": "Adult Health Nurse Practitioner",
          "LicenseNumber": "369162-4405",
          "LicenseNumberStateCode": "UT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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