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1568599207 NPI number — ELSA BOAYES HORN M.D.

NPI Number: 1568599207
Health Care Provider/Practitioner: ELSA BOAYES HORN M.D.

Information about “1568599207” NPI (ELSA BOAYES HORN M.D.) exists in 1568599207 in HTML format HTML  |  1568599207 in plain Text format TXT  |  1568599207 in PDF (Portable Document Format) PDF  |  1568599207 in an XML format XML  formats.

NPI Number : 1568599207 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568599207",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HORN",
    "FirstName": "ELSA",
    "MiddleName": "BOAYES",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DOROIN-HORN",
    "OtherFirstName": "ELSA",
    "OtherMiddleName": "B",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.D",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "22 RIDGEWOOD CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FOND DU LAC",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54935-7623",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "920-921-3324",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "W9071 FOREST DRIVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PLYMOUTH",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53073-0031",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "920-526-3044",
    "PracticeLocationAddressFaxNumber": "920-526-3819",
    "EnumerationDate": "02/28/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "174400000X",
        "TaxonomyName": "Specialist",
        "LicenseNumber": "19343",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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