NPI Code Detail JSON Logo

1255706065 NPI number — SUZETTE MARSHALYN PRENDERGAST NURSE PRACTITIONER

NPI Number: 1255706065
Health Care Provider/Practitioner: SUZETTE MARSHALYN PRENDERGAST NURSE PRACTITIONER

Information about “1255706065” NPI (SUZETTE MARSHALYN PRENDERGAST NURSE PRACTITIONER) exists in 1255706065 in HTML format HTML  |  1255706065 in plain Text format TXT  |  1255706065 in PDF (Portable Document Format) PDF  |  1255706065 in an XML format XML  formats.

NPI Number : 1255706065 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255706065",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PRENDERGAST",
    "FirstName": "SUZETTE",
    "MiddleName": "MARSHALYN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NURSE PRACTITIONER",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PRENDERGAST",
    "OtherFirstName": "SUZETTE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "213 S JEFFERSON ST STE 1006",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROANOKE",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "24011-1713",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "540-224-5452",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1 HEALTH CIR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LEXINGTON",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "24450-2448",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "540-458-3300",
    "PracticeLocationAddressFaxNumber": "540-458-3456",
    "EnumerationDate": "12/04/2015",
    "LastUpdateDate": "12/16/2025",
    "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": "363LG0600X",
          "TaxonomyName": "Gerontology Nurse Practitioner",
          "LicenseNumber": "0024188130",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363LG0600X",
          "TaxonomyName": "Gerontology Nurse Practitioner",
          "LicenseNumber": "APRN9180833",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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