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1568549996 NPI number — DEIRDRE BRIANNE CANNON PAC

NPI Number: 1568549996
Health Care Provider/Practitioner: DEIRDRE BRIANNE CANNON PAC

Information about “1568549996” NPI (DEIRDRE BRIANNE CANNON PAC) exists in 1568549996 in HTML format HTML  |  1568549996 in plain Text format TXT  |  1568549996 in PDF (Portable Document Format) PDF  |  1568549996 in an XML format XML  formats.

NPI Number : 1568549996 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568549996",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CANNON",
    "FirstName": "DEIRDRE",
    "MiddleName": "BRIANNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "160 HAWLEY LN",
    "SecondLineMailingAddress": "SUITE 104",
    "MailingAddressCityName": "TRUMBULL",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06611-5300",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-377-0639",
    "MailingAddressFaxNumber": "203-386-9706",
    "FirstLinePracticeLocationAddress": "160 HAWLEY LN",
    "SecondLinePracticeLocationAddress": "SUITE 104",
    "PracticeLocationAddressCityName": "TRUMBULL",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06611-5300",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-377-0639",
    "PracticeLocationAddressFaxNumber": "203-386-9706",
    "EnumerationDate": "11/01/2006",
    "LastUpdateDate": "03/26/2014",
    "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": "207N00000X",
        "TaxonomyName": "Dermatology Physician",
        "LicenseNumber": "001826",
        "LicenseNumberStateCode": "CT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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