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1477915205 NPI number — EMILY C JACKSON CRNA

NPI Number: 1477915205
Health Care Provider/Practitioner: EMILY C JACKSON CRNA

Information about “1477915205” NPI (EMILY C JACKSON CRNA) exists in 1477915205 in HTML format HTML  |  1477915205 in plain Text format TXT  |  1477915205 in PDF (Portable Document Format) PDF  |  1477915205 in an XML format XML  formats.

NPI Number : 1477915205 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477915205",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSON",
    "FirstName": "EMILY",
    "MiddleName": "C",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRNA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HO",
    "OtherFirstName": "EMILY",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "CRNA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 840842",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DALLAS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75284-0862",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "206-625-0578",
    "MailingAddressFaxNumber": "206-625-9184",
    "FirstLinePracticeLocationAddress": "600 BROADWAY STE 270",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SEATTLE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98122-5392",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "206-625-0578",
    "PracticeLocationAddressFaxNumber": "206-625-9184",
    "EnumerationDate": "03/22/2016",
    "LastUpdateDate": "03/24/2023",
    "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": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "RN60635784",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "AP60652208",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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