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1285592162 NPI number — EMMA KRISTINE MANDOUH NP

NPI Number: 1285592162
Health Care Provider/Practitioner: EMMA KRISTINE MANDOUH NP

Information about “1285592162” NPI (EMMA KRISTINE MANDOUH NP) exists in 1285592162 in HTML format HTML  |  1285592162 in plain Text format TXT  |  1285592162 in PDF (Portable Document Format) PDF  |  1285592162 in an XML format XML  formats.

NPI Number : 1285592162 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285592162",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MANDOUH",
    "FirstName": "EMMA",
    "MiddleName": "KRISTINE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "TAYLOR",
    "OtherFirstName": "EMMA",
    "OtherMiddleName": "KRISTINE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "NP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3400 E JOLLY RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LANSING",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48910-8542",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3400 E JOLLY RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LANSING",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48910-8542",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "517-997-8181",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/12/2026",
    "LastUpdateDate": "01/12/2026",
    "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": "163WG0000X",
        "TaxonomyName": "General Practice Registered Nurse",
        "LicenseNumber": "4704362447",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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