1174707566 NPI number — COLETTE CLARICE KUZNIA MED MASTERS DEGREE I

NPI Number: 1174707566
Health Care Provider/Practitioner: COLETTE CLARICE KUZNIA MED MASTERS DEGREE I

NPI Number : 1174707566 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174707566",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KUZNIA",
    "FirstName": "COLETTE",
    "MiddleName": "CLARICE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "MED MASTERS DEGREE I",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "403 CENTER AVE",
    "SecondLineMailingAddress": "SUITE 405 COLETTE C KUZNIA",
    "MailingAddressCityName": "MOORHEAD",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "56560",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "218-233-9426",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "403 CENTER AVE",
    "SecondLinePracticeLocationAddress": "SUITE 405",
    "PracticeLocationAddressCityName": "MOORHEAD",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "56560",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "218-233-9426",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/21/2007",
    "LastUpdateDate": "07/21/2014",
    "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": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "00117",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "25811117",
          "LicenseNumberStateCode": "ND",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "30474",
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}