1548396849 NPI number — SANDRA PETERSEN DNP,APRN, GNP-C

NPI Number: 1548396849
Health Care Provider/Practitioner: SANDRA PETERSEN DNP,APRN, GNP-C

NPI Number : 1548396849 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548396849",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PETERSEN",
    "FirstName": "SANDRA",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DNP,APRN, GNP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6827 DEL NORTE LN",
    "SecondLineMailingAddress": "SUITE 101",
    "MailingAddressCityName": "DALLAS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75225-2552",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "214-213-4726",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6800 WEST LOOP S",
    "SecondLinePracticeLocationAddress": "SUITE 180",
    "PracticeLocationAddressCityName": "BELLAIRE",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77401-4528",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "713-981-6125",
    "PracticeLocationAddressFaxNumber": "713-664-7656",
    "EnumerationDate": "02/23/2007",
    "LastUpdateDate": "03/20/2012",
    "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": "363LG0600X",
          "TaxonomyName": "Gerontology Nurse Practitioner",
          "LicenseNumber": "596367",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "596367",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}