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1275846420 NPI number — MICHELLE RENEE REILLO RN, NP, PHD

NPI Number: 1275846420
Health Care Provider/Practitioner: MICHELLE RENEE REILLO RN, NP, PHD

Information about “1275846420” NPI (MICHELLE RENEE REILLO RN, NP, PHD) exists in 1275846420 in HTML format HTML  |  1275846420 in plain Text format TXT  |  1275846420 in PDF (Portable Document Format) PDF  |  1275846420 in an XML format XML  formats.

NPI Number : 1275846420 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275846420",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "REILLO",
    "FirstName": "MICHELLE",
    "MiddleName": "RENEE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "RN, NP, PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "129 SEAGROVE MAIN STREET",
    "SecondLineMailingAddress": "UNIT 202",
    "MailingAddressCityName": "ST. AUGUSTINE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32080",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "804-296-4094",
    "MailingAddressFaxNumber": "904-217-0153",
    "FirstLinePracticeLocationAddress": "129 SEAGROVE MAIN STREET",
    "SecondLinePracticeLocationAddress": "202",
    "PracticeLocationAddressCityName": "ST. AUGUSTINE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32080",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "804-296-4094",
    "PracticeLocationAddressFaxNumber": "904-217-0153",
    "EnumerationDate": "07/16/2010",
    "LastUpdateDate": "01/07/2011",
    "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": "163WC0200X",
          "TaxonomyName": "Critical Care Medicine Registered Nurse",
          "LicenseNumber": "R080304",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "261QA1903X",
          "TaxonomyName": "Ambulatory Surgical Clinic/Center",
          "LicenseNumber": "RN 9303002",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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