1467756502 NPI number — SUZANNE H SPROUL B.S., M.S. PA-C

NPI Number: 1467756502
Health Care Provider/Practitioner: SUZANNE H SPROUL B.S., M.S. PA-C

NPI Number : 1467756502 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467756502",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SPROUL",
    "FirstName": "SUZANNE",
    "MiddleName": "H",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "B.S., M.S. PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HIRST",
    "OtherFirstName": "SUZANNE",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "907 GEORGIANA ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORT ANGELES",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98362-3911",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-565-0999",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "907 GEORGIANA ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORT ANGELES",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98362",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "540-818-8674",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/04/2011",
    "LastUpdateDate": "07/09/2025",
    "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": "PA60316417",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "0110008647",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}