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1275774440 NPI number — JONATHAN RENE BRONISTE APN

NPI Number: 1275774440
Health Care Provider/Practitioner: JONATHAN RENE BRONISTE APN

Information about “1275774440” NPI (JONATHAN RENE BRONISTE APN) exists in 1275774440 in HTML format HTML  |  1275774440 in plain Text format TXT  |  1275774440 in PDF (Portable Document Format) PDF  |  1275774440 in an XML format XML  formats.

NPI Number : 1275774440 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275774440",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRONISTE",
    "FirstName": "JONATHAN",
    "MiddleName": "RENE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "APN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "603 S DIVISION ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAVACA",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72941-4129",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "479-674-9181",
    "MailingAddressFaxNumber": "479-674-8105",
    "FirstLinePracticeLocationAddress": "603 S DIVISION ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAVACA",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72941-4129",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "479-674-9181",
    "PracticeLocationAddressFaxNumber": "479-674-8105",
    "EnumerationDate": "03/17/2009",
    "LastUpdateDate": "09/23/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363L00000X",
        "TaxonomyName": "Nurse Practitioner",
        "LicenseNumber": "A03206",
        "LicenseNumberStateCode": "AR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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