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1215561956 NPI number — STEPHANIE NICOLE LOVELAND ATC

NPI Number: 1215561956
Health Care Provider/Practitioner: STEPHANIE NICOLE LOVELAND ATC

Information about “1215561956” NPI (STEPHANIE NICOLE LOVELAND ATC) exists in 1215561956 in HTML format HTML  |  1215561956 in plain Text format TXT  |  1215561956 in PDF (Portable Document Format) PDF  |  1215561956 in an XML format XML  formats.

NPI Number : 1215561956 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215561956",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LOVELAND",
    "FirstName": "STEPHANIE",
    "MiddleName": "NICOLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LYDA",
    "OtherFirstName": "STEPHANIE",
    "OtherMiddleName": "NICOLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "ATC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6836 N SMITH ST APT A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORTLAND",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97203-2579",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-752-0730",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5405 SE WOODWARD ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORTLAND",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97206-2168",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-916-5140",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/02/2020",
    "LastUpdateDate": "03/02/2020",
    "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": "AT-10169687",
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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