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1194500785 NPI number — ADDISON MAE LARRALDE NP

NPI Number: 1194500785
Health Care Provider/Practitioner: ADDISON MAE LARRALDE NP

Information about “1194500785” NPI (ADDISON MAE LARRALDE NP) exists in 1194500785 in HTML format HTML  |  1194500785 in plain Text format TXT  |  1194500785 in PDF (Portable Document Format) PDF  |  1194500785 in an XML format XML  formats.

NPI Number : 1194500785 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194500785",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LARRALDE",
    "FirstName": "ADDISON",
    "MiddleName": "MAE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GUNTHER",
    "OtherFirstName": "ADDISON",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "NP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3260 N HAYDEN RD STE 112",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SCOTTSDALE",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85251-6650",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "602-264-9100",
    "MailingAddressFaxNumber": "602-264-9101",
    "FirstLinePracticeLocationAddress": "8573 E PRINCESS DR STE 215",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SCOTTSDALE",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85255-7824",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "480-563-5757",
    "PracticeLocationAddressFaxNumber": "480-513-2443",
    "EnumerationDate": "08/30/2023",
    "LastUpdateDate": "04/21/2026",
    "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": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "260433",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "260433",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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