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1326695792 NPI number — HEIDI MICHELLE SANTIAGO PA-C

NPI Number: 1326695792
Health Care Provider/Practitioner: HEIDI MICHELLE SANTIAGO PA-C

Information about “1326695792” NPI (HEIDI MICHELLE SANTIAGO PA-C) exists in 1326695792 in HTML format HTML  |  1326695792 in plain Text format TXT  |  1326695792 in PDF (Portable Document Format) PDF  |  1326695792 in an XML format XML  formats.

NPI Number : 1326695792 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1326695792",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SANTIAGO",
    "FirstName": "HEIDI",
    "MiddleName": "MICHELLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WALBERG",
    "OtherFirstName": "HEIDI",
    "OtherMiddleName": "MICHELLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "300 POST RD W",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WESTPORT",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06880-4703",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-332-3272",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "300 POST RD W",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WESTPORT",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06880-4703",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-332-3272",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/21/2019",
    "LastUpdateDate": "11/13/2024",
    "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": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "4630",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "4630",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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