1194287714 NPI number — TONJA A LUEDERS M.ED., LAT, ATC

NPI Number: 1194287714
Health Care Provider/Practitioner: TONJA A LUEDERS M.ED., LAT, ATC

NPI Number : 1194287714 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194287714",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LUEDERS",
    "FirstName": "TONJA",
    "MiddleName": "A",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.ED., LAT, ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "750 SE DOUGLAS ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BEND",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97702-1432",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-867-5083",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "500 E VETERANS WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TEMPE",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85287-0001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "480-965-0185",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/02/2019",
    "LastUpdateDate": "06/18/2019",
    "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": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "001571",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "AT-10200149",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}