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1356206890 NPI number — THE FAIRY TOX-MOTHER INC.

NPI Number: 1356206890
Health Care Provider/Practitioner: THE FAIRY TOX-MOTHER INC.

Information about “1356206890” NPI (THE FAIRY TOX-MOTHER INC.) exists in 1356206890 in HTML format HTML  |  1356206890 in plain Text format TXT  |  1356206890 in PDF (Portable Document Format) PDF  |  1356206890 in an XML format XML  formats.

NPI Number : 1356206890 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1356206890",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "THE FAIRY TOX-MOTHER INC.",
    "ParentOrgTIN": null,
    "OrgName": "THE FAIRY TOX-MOTHER INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3913 CAMEO DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OCEANSIDE",
    "MailingAddressStateName": "CALIFORNIA",
    "MailingAddressPostalCode": "92056",
    "MailingAddressCountryCode": "UM",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2401 VISTA WAY",
    "SecondLinePracticeLocationAddress": "SUITE A",
    "PracticeLocationAddressCityName": "OCEANSIDE",
    "PracticeLocationAddressStateName": "CALIFORNIA",
    "PracticeLocationAddressPostalCode": "92056",
    "PracticeLocationAddressCountryCode": "UM",
    "PracticeLocationAddressTelephoneNumber": null,
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/17/2025",
    "LastUpdateDate": "12/17/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BOLSTON",
    "AuthorizedOfficialFirstName": "EMELY",
    "AuthorizedOfficialMiddleName": "MARIE",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "NP",
    "AuthorizedOfficialTelephoneNumber": "442-202-4635",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LA2200X",
        "TaxonomyName": "Adult Health Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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