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1194153494 NPI number — JULIA ESTHER BALCOM MN,BSN

NPI Number: 1194153494
Health Care Provider/Practitioner: JULIA ESTHER BALCOM MN,BSN

Information about “1194153494” NPI (JULIA ESTHER BALCOM MN,BSN) exists in 1194153494 in HTML format HTML  |  1194153494 in plain Text format TXT  |  1194153494 in PDF (Portable Document Format) PDF  |  1194153494 in an XML format XML  formats.

NPI Number : 1194153494 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194153494",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BALCOM",
    "FirstName": "JULIA",
    "MiddleName": "ESTHER",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MN,BSN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "THOMAS",
    "OtherFirstName": "JULIA",
    "OtherMiddleName": "ESTHER",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 1517",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PENDLETON",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97801-0410",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "877-708-1119",
    "MailingAddressFaxNumber": "541-278-8349",
    "FirstLinePracticeLocationAddress": "531 SE CLAY ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97338-2865",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "971-612-6100",
    "PracticeLocationAddressFaxNumber": "971-612-6101",
    "EnumerationDate": "10/23/2013",
    "LastUpdateDate": "09/10/2021",
    "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": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "201391421NP-PP",
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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