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1497418180 NPI number — PHOEBE MARCELLA KNIGHT PA-C

NPI Number: 1497418180
Health Care Provider/Practitioner: PHOEBE MARCELLA KNIGHT PA-C

Information about “1497418180” NPI (PHOEBE MARCELLA KNIGHT PA-C) exists in 1497418180 in HTML format HTML  |  1497418180 in plain Text format TXT  |  1497418180 in PDF (Portable Document Format) PDF  |  1497418180 in an XML format XML  formats.

NPI Number : 1497418180 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497418180",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KNIGHT",
    "FirstName": "PHOEBE",
    "MiddleName": "MARCELLA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MULARONI",
    "OtherFirstName": "PHOEBE",
    "OtherMiddleName": "MARCELLA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6330 ORCHARD LAKE RD STE 120",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST BLOOMFIELD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48322-2398",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-462-6045",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "46325 W 12 MILE RD STE 370",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NOVI",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48377-2464",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "248-482-2103",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/19/2021",
    "LastUpdateDate": "11/25/2024",
    "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": "363AM0700X",
        "TaxonomyName": "Medical Physician Assistant",
        "LicenseNumber": "5601010859",
        "LicenseNumberStateCode": "MI",
        "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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