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1548179666 NPI number — KAELA MARIE HENDRICKS

NPI Number: 1548179666
Health Care Provider/Practitioner: KAELA MARIE HENDRICKS

Information about “1548179666” NPI (KAELA MARIE HENDRICKS) exists in 1548179666 in HTML format HTML  |  1548179666 in plain Text format TXT  |  1548179666 in PDF (Portable Document Format) PDF  |  1548179666 in an XML format XML  formats.

NPI Number : 1548179666 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548179666",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HENDRICKS",
    "FirstName": "KAELA",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "VANDERLOOP",
    "OtherFirstName": "KAELA",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "744 S WEBSTER AVE",
    "SecondLineMailingAddress": "MEDICAL STAFF SERVICES",
    "MailingAddressCityName": "GREEN BAY",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54301-3505",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "720 S VAN BUREN ST STE 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GREEN BAY",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54301-3534",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "920-433-7488",
    "PracticeLocationAddressFaxNumber": "920-433-7439",
    "EnumerationDate": "09/03/2026",
    "LastUpdateDate": "09/03/2026",
    "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": "163W00000X",
        "TaxonomyName": "Registered Nurse",
        "LicenseNumber": "242707-30",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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