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1497030811 NPI number — JEANETTA JEAN SHRIVER FNP-BC

NPI Number: 1497030811
Health Care Provider/Practitioner: JEANETTA JEAN SHRIVER FNP-BC

Information about “1497030811” NPI (JEANETTA JEAN SHRIVER FNP-BC) exists in 1497030811 in HTML format HTML  |  1497030811 in plain Text format TXT  |  1497030811 in PDF (Portable Document Format) PDF  |  1497030811 in an XML format XML  formats.

NPI Number : 1497030811 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497030811",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHRIVER",
    "FirstName": "JEANETTA",
    "MiddleName": "JEAN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "FNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SHRIVER FNP-BC",
    "OtherFirstName": "JEANETTA",
    "OtherMiddleName": "JEAN",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "MSN  FNP-BC",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "294 E MAIN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSON",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45640-1745",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "740-577-3132",
    "MailingAddressFaxNumber": "740-577-3156",
    "FirstLinePracticeLocationAddress": "294 E MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSON",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45640-1745",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "740-577-3132",
    "PracticeLocationAddressFaxNumber": "740-577-3156",
    "EnumerationDate": "10/17/2011",
    "LastUpdateDate": "07/17/2012",
    "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": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "COA12752-NP",
        "LicenseNumberStateCode": "OH",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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