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1427222355 NPI number — NICOLE JEANETTE WEERSING PA-C

NPI Number: 1427222355
Health Care Provider/Practitioner: NICOLE JEANETTE WEERSING PA-C

Information about “1427222355” NPI (NICOLE JEANETTE WEERSING PA-C) exists in 1427222355 in HTML format HTML  |  1427222355 in plain Text format TXT  |  1427222355 in PDF (Portable Document Format) PDF  |  1427222355 in an XML format XML  formats.

NPI Number : 1427222355 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1427222355",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WEERSING",
    "FirstName": "NICOLE",
    "MiddleName": "JEANETTE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MECHALY",
    "OtherFirstName": "NICOLE",
    "OtherMiddleName": "JEANETTE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2401 W BELVEDERE AVE",
    "SecondLineMailingAddress": "ATTN: CREDENTIALING",
    "MailingAddressCityName": "BALTIMORE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21215-5216",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "410-601-5523",
    "MailingAddressFaxNumber": "410-601-8946",
    "FirstLinePracticeLocationAddress": "2435 W BELVEDERE AVE",
    "SecondLinePracticeLocationAddress": "SUITE 35",
    "PracticeLocationAddressCityName": "BALTIMORE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21215-5224",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "410-601-0900",
    "PracticeLocationAddressFaxNumber": "410-601-0901",
    "EnumerationDate": "04/22/2008",
    "LastUpdateDate": "08/03/2010",
    "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": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "C03106",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "C03106",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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