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1497884134 NPI number — STEFANI JANE BEVERLIN PAC

NPI Number: 1497884134
Health Care Provider/Practitioner: STEFANI JANE BEVERLIN PAC

Information about “1497884134” NPI (STEFANI JANE BEVERLIN PAC) exists in 1497884134 in HTML format HTML  |  1497884134 in plain Text format TXT  |  1497884134 in PDF (Portable Document Format) PDF  |  1497884134 in an XML format XML  formats.

NPI Number : 1497884134 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497884134",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BEVERLIN",
    "FirstName": "STEFANI",
    "MiddleName": "JANE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "VOUDRIE",
    "OtherFirstName": "STEFANI",
    "OtherMiddleName": "JANE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "ATC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 784",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EFFINGHAM",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62401-0784",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "217-342-3337",
    "MailingAddressFaxNumber": "217-347-3328",
    "FirstLinePracticeLocationAddress": "912 N HENRIETTA ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EFFINGHAM",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62401-1788",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "217-342-3337",
    "PracticeLocationAddressFaxNumber": "217-347-3328",
    "EnumerationDate": "03/05/2007",
    "LastUpdateDate": "09/25/2015",
    "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": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "096.002319",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "085005584",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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