NPI Code Detail JSON Logo

1215174990 NPI number — LISA ANN JACKSON CRNA

NPI Number: 1215174990
Health Care Provider/Practitioner: LISA ANN JACKSON CRNA

Information about “1215174990” NPI (LISA ANN JACKSON CRNA) exists in 1215174990 in HTML format HTML  |  1215174990 in plain Text format TXT  |  1215174990 in PDF (Portable Document Format) PDF  |  1215174990 in an XML format XML  formats.

NPI Number : 1215174990 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215174990",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSON",
    "FirstName": "LISA ANN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRNA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JACKSON",
    "OtherFirstName": "LISA ANN",
    "OtherMiddleName": "VIGNOLA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "CRNA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 650782",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DALLAS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75265",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "610-789-8070",
    "MailingAddressFaxNumber": "610-789-9937",
    "FirstLinePracticeLocationAddress": "2010 OLD W CHESTER PIKE",
    "SecondLinePracticeLocationAddress": "SUITE 330",
    "PracticeLocationAddressCityName": "HAVERTOWN",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "19083-2712",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "610-789-8070",
    "PracticeLocationAddressFaxNumber": "610-789-9937",
    "EnumerationDate": "01/16/2009",
    "LastUpdateDate": "01/16/2009",
    "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": "367500000X",
        "TaxonomyName": "Certified Registered Nurse Anesthetist",
        "LicenseNumber": "081637",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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