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1265179808 NPI number — COURTNEY SHAREE PAGE RC 72216

NPI Number: 1265179808
Health Care Provider/Practitioner: COURTNEY SHAREE PAGE RC 72216

Information about “1265179808” NPI (COURTNEY SHAREE PAGE RC 72216) exists in 1265179808 in HTML format HTML  |  1265179808 in plain Text format TXT  |  1265179808 in PDF (Portable Document Format) PDF  |  1265179808 in an XML format XML  formats.

NPI Number : 1265179808 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265179808",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PAGE",
    "FirstName": "COURTNEY",
    "MiddleName": "SHAREE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "RC 72216",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6625 VALLEYBROOK RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBIA",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29206-1052",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "803-238-6608",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9320 TWO NOTCH RD STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBIA",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29223-6402",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "803-238-6608",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/16/2022",
    "LastUpdateDate": "05/16/2022",
    "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": "1744P3200X",
        "TaxonomyName": "Prosthetics Case Management",
        "LicenseNumber": "72216",
        "LicenseNumberStateCode": "SC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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