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1508942343 NPI number — COREY REX PETERSON CRNA

NPI Number: 1508942343
Health Care Provider/Practitioner: COREY REX PETERSON CRNA

Information about “1508942343” NPI (COREY REX PETERSON CRNA) exists in 1508942343 in HTML format HTML  |  1508942343 in plain Text format TXT  |  1508942343 in PDF (Portable Document Format) PDF  |  1508942343 in an XML format XML  formats.

NPI Number : 1508942343 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1508942343",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PETERSON",
    "FirstName": "COREY",
    "MiddleName": "REX",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "CRNA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4478 SPARKLEBERRY CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EVANS",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30809-4454",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "706-860-7362",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2260 WRIGHTSBORO RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AUGUSTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30904-4764",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-736-2273",
    "PracticeLocationAddressFaxNumber": "706-736-7171",
    "EnumerationDate": "10/27/2006",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "367500000X",
        "TaxonomyName": "Certified Registered Nurse Anesthetist",
        "LicenseNumber": "RN168422",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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