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1457984460 NPI number — MRS. CARISSA WELTON NIEMERG

NPI Number: 1457984460
Health Care Provider/Practitioner: MRS. CARISSA WELTON NIEMERG

Information about “1457984460” NPI (MRS. CARISSA WELTON NIEMERG) exists in 1457984460 in HTML format HTML  |  1457984460 in plain Text format TXT  |  1457984460 in PDF (Portable Document Format) PDF  |  1457984460 in an XML format XML  formats.

NPI Number : 1457984460 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457984460",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NIEMERG",
    "FirstName": "CARISSA",
    "MiddleName": "WELTON",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GOOSTREE",
    "OtherFirstName": "CARISSA",
    "OtherMiddleName": "WELTON",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "14535 N AMBER LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EFFINGHAM",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62401-4340",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "618-322-6918",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "14535 N AMBER LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EFFINGHAM",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62401-4340",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "618-322-6918",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/18/2020",
    "LastUpdateDate": "02/18/2020",
    "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": "222Q00000X",
        "TaxonomyName": "Developmental Therapist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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