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1548986565 NPI number — MARY JANE CLARK RN, CHES

NPI Number: 1548986565
Health Care Provider/Practitioner: MARY JANE CLARK RN, CHES

Information about “1548986565” NPI (MARY JANE CLARK RN, CHES) exists in 1548986565 in HTML format HTML  |  1548986565 in plain Text format TXT  |  1548986565 in PDF (Portable Document Format) PDF  |  1548986565 in an XML format XML  formats.

NPI Number : 1548986565 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548986565",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CLARK",
    "FirstName": "MARY",
    "MiddleName": "JANE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "RN, CHES",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MAYS",
    "OtherFirstName": "MARY",
    "OtherMiddleName": "JANE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 160",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CARTHAGE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62321-0160",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "217-357-6832",
    "MailingAddressFaxNumber": "217-357-6839",
    "FirstLinePracticeLocationAddress": "1450 N COUNTY ROAD 2050 E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CARTHAGE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62321-3551",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "217-357-6832",
    "PracticeLocationAddressFaxNumber": "217-357-6839",
    "EnumerationDate": "10/12/2022",
    "LastUpdateDate": "10/12/2022",
    "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": "171400000X",
        "TaxonomyName": "Health & Wellness Coach",
        "LicenseNumber": "9468",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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