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1255874079 NPI number — SANDRA LORENA BENITEZ KRUIDENIER PA-C

NPI Number: 1255874079
Health Care Provider/Practitioner: SANDRA LORENA BENITEZ KRUIDENIER PA-C

Information about “1255874079” NPI (SANDRA LORENA BENITEZ KRUIDENIER PA-C) exists in 1255874079 in HTML format HTML  |  1255874079 in plain Text format TXT  |  1255874079 in PDF (Portable Document Format) PDF  |  1255874079 in an XML format XML  formats.

NPI Number : 1255874079 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255874079",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BENITEZ KRUIDENIER",
    "FirstName": "SANDRA",
    "MiddleName": "LORENA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BENITEZ",
    "OtherFirstName": "SANDRA",
    "OtherMiddleName": "LORENA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "PO BOX 25608",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALT LAKE CITY",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84125-0608",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "206-320-4476",
    "MailingAddressFaxNumber": "206-568-7043",
    "FirstLinePracticeLocationAddress": "1221 MADISON ST",
    "SecondLinePracticeLocationAddress": "STE 1020",
    "PracticeLocationAddressCityName": "SEATTLE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98104-1380",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "206-215-2658",
    "PracticeLocationAddressFaxNumber": "206-991-2363",
    "EnumerationDate": "11/28/2016",
    "LastUpdateDate": "01/17/2022",
    "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": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "PA61115668",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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