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1316533839 NPI number — KAITLIN ROSE MART PHARMD

NPI Number: 1316533839
Health Care Provider/Practitioner: KAITLIN ROSE MART PHARMD

Information about “1316533839” NPI (KAITLIN ROSE MART PHARMD) exists in 1316533839 in HTML format HTML  |  1316533839 in plain Text format TXT  |  1316533839 in PDF (Portable Document Format) PDF  |  1316533839 in an XML format XML  formats.

NPI Number : 1316533839 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1316533839",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MART",
    "FirstName": "KAITLIN",
    "MiddleName": "ROSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KEYWORTH",
    "OtherFirstName": "KAITLIN",
    "OtherMiddleName": "ROSE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PHARMD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1440 UNIVERSITY AVE W",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT PAUL",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55104-4012",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "651-646-8858",
    "MailingAddressFaxNumber": "651-646-9699",
    "FirstLinePracticeLocationAddress": "1440 UNIVERSITY AVE W",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT PAUL",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55104-4012",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-646-8858",
    "PracticeLocationAddressFaxNumber": "651-646-9699",
    "EnumerationDate": "12/18/2020",
    "LastUpdateDate": "12/18/2020",
    "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": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "123023",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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