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1396008868 NPI number — MRS. DESIRAE ANNE CROWELL

NPI Number: 1396008868
Health Care Provider/Practitioner: MRS. DESIRAE ANNE CROWELL

Information about “1396008868” NPI (MRS. DESIRAE ANNE CROWELL) exists in 1396008868 in HTML format HTML  |  1396008868 in plain Text format TXT  |  1396008868 in PDF (Portable Document Format) PDF  |  1396008868 in an XML format XML  formats.

NPI Number : 1396008868 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396008868",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CROWELL",
    "FirstName": "DESIRAE",
    "MiddleName": "ANNE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CELIBERTI",
    "OtherFirstName": "DESIRAE",
    "OtherMiddleName": "ANNE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1219 DUNN AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAYTONA BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32114-2405",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1219 DUNN AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAYTONA BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32114-2405",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "386-931-6227",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/20/2012",
    "LastUpdateDate": "06/22/2021",
    "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": "174400000X",
          "TaxonomyName": "Specialist",
          "LicenseNumber": "607155121",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "1-16-21492",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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