1396183273 NPI number — CHERYL RENEE HOLLINGSWORTH R.N., CADAC II

NPI Number: 1396183273
Health Care Provider/Practitioner: CHERYL RENEE HOLLINGSWORTH R.N., CADAC II

NPI Number : 1396183273 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396183273",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HOLLINGSWORTH",
    "FirstName": "CHERYL",
    "MiddleName": "RENEE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "R.N., CADAC II",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "114 N MAIN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GOSHEN",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46526-3207",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "574-533-6154",
    "MailingAddressFaxNumber": "574-534-3951",
    "FirstLinePracticeLocationAddress": "204 S MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ELKHART",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46516-3120",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "574-293-1086",
    "PracticeLocationAddressFaxNumber": "574-522-7461",
    "EnumerationDate": "06/12/2013",
    "LastUpdateDate": "06/12/2013",
    "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": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163WA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Registered Nurse",
          "LicenseNumber": "28125454A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}