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1508277336 NPI number — MEREDITH RUSSELL

NPI Number: 1508277336
Health Care Provider/Practitioner: MEREDITH RUSSELL

Information about “1508277336” NPI (MEREDITH RUSSELL) exists in 1508277336 in HTML format HTML  |  1508277336 in plain Text format TXT  |  1508277336 in PDF (Portable Document Format) PDF  |  1508277336 in an XML format XML  formats.

NPI Number : 1508277336 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1508277336",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RUSSELL",
    "FirstName": "MEREDITH",
    "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": "235 WEALTHY ST SE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GRAND RAPIDS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49503-5247",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "616-840-8000",
    "MailingAddressFaxNumber": "616-840-9690",
    "FirstLinePracticeLocationAddress": "5900 BYRON CENTER AVE SW",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WYOMING",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49519-9606",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "616-252-7200",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/14/2014",
    "LastUpdateDate": "02/07/2025",
    "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": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "9918",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208100000X",
          "TaxonomyName": "Physical Medicine & Rehabilitation Physician",
          "LicenseNumber": "5501303341",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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