1407912470 NPI number — PAMELA SUE LANGENDERFER N.M.D, M.S.O.M., LAC

NPI Number: 1407912470
Health Care Provider/Practitioner: PAMELA SUE LANGENDERFER N.M.D, M.S.O.M., LAC

NPI Number : 1407912470 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407912470",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LANGENDERFER",
    "FirstName": "PAMELA",
    "MiddleName": "SUE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "N.M.D, M.S.O.M., LAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "518 N 4TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COEUR D ALENE",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83814-2931",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-758-0568",
    "MailingAddressFaxNumber": "833-810-1162",
    "FirstLinePracticeLocationAddress": "518 N 4TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COEUR D ALENE",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83814-2931",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-758-0568",
    "PracticeLocationAddressFaxNumber": "833-810-1162",
    "EnumerationDate": "12/27/2006",
    "LastUpdateDate": "03/24/2021",
    "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": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "ACU-148",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "AC60282929",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175F00000X",
          "TaxonomyName": "Naturopath",
          "LicenseNumber": "NAT-4",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175F00000X",
          "TaxonomyName": "Naturopath",
          "LicenseNumber": "NMD-0020",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175F00000X",
          "TaxonomyName": "Naturopath",
          "LicenseNumber": "NT-1257",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}