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1457361990 NPI number — AMANDA LYNN ANDERSON ATC

NPI Number: 1457361990
Health Care Provider/Practitioner: AMANDA LYNN ANDERSON ATC

Information about “1457361990” NPI (AMANDA LYNN ANDERSON ATC) exists in 1457361990 in HTML format HTML  |  1457361990 in plain Text format TXT  |  1457361990 in PDF (Portable Document Format) PDF  |  1457361990 in an XML format XML  formats.

NPI Number : 1457361990 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457361990",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ANDERSON",
    "FirstName": "AMANDA",
    "MiddleName": "LYNN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "319 W RIVERSIDE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKEMOOR",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60051-8774",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-486-4627",
    "MailingAddressFaxNumber": "847-486-5702",
    "FirstLinePracticeLocationAddress": "4000 W LAKE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GLENVIEW",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60026-1239",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-486-4627",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/08/2006",
    "LastUpdateDate": "12/07/2011",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "096.001971",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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