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1568936847 NPI number — ANNETTE DIANE MONK MS, LAT, ATC

NPI Number: 1568936847
Health Care Provider/Practitioner: ANNETTE DIANE MONK MS, LAT, ATC

Information about “1568936847” NPI (ANNETTE DIANE MONK MS, LAT, ATC) exists in 1568936847 in HTML format HTML  |  1568936847 in plain Text format TXT  |  1568936847 in PDF (Portable Document Format) PDF  |  1568936847 in an XML format XML  formats.

NPI Number : 1568936847 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568936847",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MONK",
    "FirstName": "ANNETTE",
    "MiddleName": "DIANE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "MS, LAT, ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9 W RUSTIC LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROUND LAKE BEACH",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60073-4059",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "815-383-3271",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2065 HALF DAY RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DEERFIELD",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60015-1241",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "815-383-3271",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/19/2019",
    "LastUpdateDate": "01/19/2019",
    "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": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "1798",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "096002385",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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