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1497627335 NPI number — AMANDA PATROCINO

NPI Number: 1497627335
Health Care Provider/Practitioner: AMANDA PATROCINO

Information about “1497627335” NPI (AMANDA PATROCINO) exists in 1497627335 in HTML format HTML  |  1497627335 in plain Text format TXT  |  1497627335 in PDF (Portable Document Format) PDF  |  1497627335 in an XML format XML  formats.

NPI Number : 1497627335 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497627335",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PATROCINO",
    "FirstName": "AMANDA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5032 HAVEN LODGE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STALLINGS",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28104-4131",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "252-558-2664",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1410 E GASTON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LINCOLNTON",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28092-4400",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-732-1138",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/20/2025",
    "LastUpdateDate": "09/20/2025",
    "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": "363L00000X",
        "TaxonomyName": "Nurse Practitioner",
        "LicenseNumber": "5023098",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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