1295928901 NPI number — MARIETA P. GROVER L.M.P. / C.N.A.

NPI Number: 1295928901
Health Care Provider/Practitioner: MARIETA P. GROVER L.M.P. / C.N.A.

NPI Number : 1295928901 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295928901",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GROVER",
    "FirstName": "MARIETA",
    "MiddleName": "P.",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "L.M.P. / C.N.A.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3815 16TH AVENUE CT NW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GIG HARBOR",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98335-1670",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-265-3348",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3815 16TH AVENUE CT NW",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GIG HARBOR",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98335-1670",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-265-3348",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/26/2007",
    "LastUpdateDate": "08/26/2007",
    "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": "225700000X",
        "TaxonomyName": "Massage Therapist",
        "LicenseNumber": "MA00016941",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}