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1336077759 NPI number — ALEXIS JEWEL HEEREN

NPI Number: 1336077759
Health Care Provider/Practitioner: ALEXIS JEWEL HEEREN

Information about “1336077759” NPI (ALEXIS JEWEL HEEREN) exists in 1336077759 in HTML format HTML  |  1336077759 in plain Text format TXT  |  1336077759 in PDF (Portable Document Format) PDF  |  1336077759 in an XML format XML  formats.

NPI Number : 1336077759 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336077759",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HEEREN",
    "FirstName": "ALEXIS",
    "MiddleName": "JEWEL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "NIMMO",
    "OtherFirstName": "ALEXIS",
    "OtherMiddleName": "JEWEL",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "18726 S WESTERN AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GARDENA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90248-3813",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-856-0800",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "13601 80TH CIR N STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MAPLE GROVE",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55369-9801",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "763-272-5877",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/13/2026",
    "LastUpdateDate": "05/13/2026",
    "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": "103K00000X",
        "TaxonomyName": "Behavior Analyst",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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