NPI Code Detail JSON Logo

1366015414 NPI number — JACQUELYN NICOLE PAGH CRNA

NPI Number: 1366015414
Health Care Provider/Practitioner: JACQUELYN NICOLE PAGH CRNA

Information about “1366015414” NPI (JACQUELYN NICOLE PAGH CRNA) exists in 1366015414 in HTML format HTML  |  1366015414 in plain Text format TXT  |  1366015414 in PDF (Portable Document Format) PDF  |  1366015414 in an XML format XML  formats.

NPI Number : 1366015414 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366015414",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PAGH",
    "FirstName": "JACQUELYN",
    "MiddleName": "NICOLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRNA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MARINCOVICH",
    "OtherFirstName": "JACQUELYN",
    "OtherMiddleName": "NICOLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "RN",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3939 E VEST AVE APT 159",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GILBERT",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85295-4694",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2615 CHESTER AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BAKERSFIELD",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93301-2014",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "520-626-6154",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/16/2021",
    "LastUpdateDate": "12/15/2025",
    "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": "367500000X",
        "TaxonomyName": "Certified Registered Nurse Anesthetist",
        "LicenseNumber": "95002669",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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