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1326109208 NPI number — AMANDA M RODRIGUEZ PA-C

NPI Number: 1326109208
Health Care Provider/Practitioner: AMANDA M RODRIGUEZ PA-C

Information about “1326109208” NPI (AMANDA M RODRIGUEZ PA-C) exists in 1326109208 in HTML format HTML  |  1326109208 in plain Text format TXT  |  1326109208 in PDF (Portable Document Format) PDF  |  1326109208 in an XML format XML  formats.

NPI Number : 1326109208 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1326109208",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RODRIGUEZ",
    "FirstName": "AMANDA",
    "MiddleName": "M",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LAMBERT",
    "OtherFirstName": "AMANDA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "801 YORK ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MANITOWOC",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54220-4630",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "920-663-9008",
    "MailingAddressFaxNumber": "920-684-1439",
    "FirstLinePracticeLocationAddress": "300 W WASHINGTON AVE STE 250",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSON",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49201-2160",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "517-539-3188",
    "PracticeLocationAddressFaxNumber": "517-539-3189",
    "EnumerationDate": "12/13/2006",
    "LastUpdateDate": "10/25/2022",
    "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": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "5601004537",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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