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1427571017 NPI number — STEPHANIE J LANE

NPI Number: 1427571017
Health Care Provider/Practitioner: STEPHANIE J LANE

Information about “1427571017” NPI (STEPHANIE J LANE) exists in 1427571017 in HTML format HTML  |  1427571017 in plain Text format TXT  |  1427571017 in PDF (Portable Document Format) PDF  |  1427571017 in an XML format XML  formats.

NPI Number : 1427571017 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1427571017",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LANE",
    "FirstName": "STEPHANIE",
    "MiddleName": "J",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GROGG",
    "OtherFirstName": "STEPHANIE",
    "OtherMiddleName": "JEAN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "284 EXECUTIVE PARK DR STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CONCORD",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28025-1833",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-939-1100",
    "MailingAddressFaxNumber": "704-939-1173",
    "FirstLinePracticeLocationAddress": "524 SIGNAL HILL DRIVE EXT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STATESVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28625-4391",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-871-1045",
    "PracticeLocationAddressFaxNumber": "704-873-6647",
    "EnumerationDate": "07/25/2017",
    "LastUpdateDate": "11/27/2023",
    "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": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "5009765",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "5009765",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "5009765",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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