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1184654865 NPI number — EVELYN NIDA BLANFORD M.A.

NPI Number: 1184654865
Health Care Provider/Practitioner: EVELYN NIDA BLANFORD M.A.

Information about “1184654865” NPI (EVELYN NIDA BLANFORD M.A.) exists in 1184654865 in HTML format HTML  |  1184654865 in plain Text format TXT  |  1184654865 in PDF (Portable Document Format) PDF  |  1184654865 in an XML format XML  formats.

NPI Number : 1184654865 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1184654865",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLANFORD",
    "FirstName": "EVELYN",
    "MiddleName": "NIDA",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "M.A.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2201 MONTCLAIR AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FLINT",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48503-2221",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "810-232-1689",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "420 W 5TH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FLINT",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48503-2445",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "810-496-5305",
    "PracticeLocationAddressFaxNumber": "810-762-5234",
    "EnumerationDate": "07/05/2006",
    "LastUpdateDate": "07/08/2007",
    "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": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "6301007707",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "PS-007741-L",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "315",
          "LicenseNumberStateCode": "WV",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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