NPI Code Detail JSON Logo

1417815218 NPI number — MOESHA REGINE MARTIN LVN

NPI Number: 1417815218
Health Care Provider/Practitioner: MOESHA REGINE MARTIN LVN

Information about “1417815218” NPI (MOESHA REGINE MARTIN LVN) exists in 1417815218 in HTML format HTML  |  1417815218 in plain Text format TXT  |  1417815218 in PDF (Portable Document Format) PDF  |  1417815218 in an XML format XML  formats.

NPI Number : 1417815218 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417815218",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MARTIN",
    "FirstName": "MOESHA",
    "MiddleName": "REGINE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LVN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2567 S ROWELL AVE APT F",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FRESNO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "93725-1560",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "559-970-0393",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "539 N VAN NESS AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FRESNO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93728-3419",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "559-266-9581",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/12/2026",
    "LastUpdateDate": "01/12/2026",
    "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": "164X00000X",
        "TaxonomyName": "Licensed Vocational Nurse",
        "LicenseNumber": "755798",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.