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1528833068 NPI number — NOUR MEDICAL SPA

NPI Number: 1528833068
Health Care Provider/Practitioner: NOUR MEDICAL SPA

Information about “1528833068” NPI (NOUR MEDICAL SPA) exists in 1528833068 in HTML format HTML  |  1528833068 in plain Text format TXT  |  1528833068 in PDF (Portable Document Format) PDF  |  1528833068 in an XML format XML  formats.

NPI Number : 1528833068 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528833068",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NOUR MEDICAL SPA",
    "LastName": null,
    "FirstName": null,
    "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": "957 BURGUNDY LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MANCHESTER",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63011-3585",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-287-8447",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "957 BURGUNDY LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MANCHESTER",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63011-3585",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-287-8447",
    "PracticeLocationAddressFaxNumber": "877-455-4214",
    "EnumerationDate": "11/15/2023",
    "LastUpdateDate": "06/21/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KAKISH",
    "AuthorizedOfficialFirstName": "SARA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER/MD",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "314-471-9119",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QH0100X",
        "TaxonomyName": "Health Service Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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