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1578834792 NPI number — CORLISS KELLY HALES RDH

NPI Number: 1578834792
Health Care Provider/Practitioner: CORLISS KELLY HALES RDH

Information about “1578834792” NPI (CORLISS KELLY HALES RDH) exists in 1578834792 in HTML format HTML  |  1578834792 in plain Text format TXT  |  1578834792 in PDF (Portable Document Format) PDF  |  1578834792 in an XML format XML  formats.

NPI Number : 1578834792 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578834792",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HALES",
    "FirstName": "CORLISS",
    "MiddleName": "KELLY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RDH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PUTIGNANO",
    "OtherFirstName": "CORLISS",
    "OtherMiddleName": "KELLY",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "RDH",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "15182 N. 75TH AVE.",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PEORIA",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85381",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "623-878-2400",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "15182 N. 75TH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PEORIA",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85381",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "623-878-2400",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/19/2012",
    "LastUpdateDate": "01/19/2012",
    "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": "124Q00000X",
          "TaxonomyName": "Dental Hygienist",
          "LicenseNumber": "H6119",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "124Q00000X",
          "TaxonomyName": "Dental Hygienist",
          "LicenseNumber": "H3927",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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