NPI Code Detail JSON Logo

1598333189 NPI number — NATHANIEL LOGAN MYERS CAA

NPI Number: 1598333189
Health Care Provider/Practitioner: NATHANIEL LOGAN MYERS CAA

Information about “1598333189” NPI (NATHANIEL LOGAN MYERS CAA) exists in 1598333189 in HTML format HTML  |  1598333189 in plain Text format TXT  |  1598333189 in PDF (Portable Document Format) PDF  |  1598333189 in an XML format XML  formats.

NPI Number : 1598333189 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598333189",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MYERS",
    "FirstName": "NATHANIEL",
    "MiddleName": "LOGAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CAA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7974 UW HEALTH CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIDDLETON",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53562-5531",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "600 HIGHLAND AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MADISON",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53792-0001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "608-263-8106",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/11/2021",
    "LastUpdateDate": "11/22/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "190-17",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "367H00000X",
          "TaxonomyName": "Anesthesiologist Assistant",
          "LicenseNumber": "2024036980",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "367H00000X",
          "TaxonomyName": "Anesthesiologist Assistant",
          "LicenseNumber": "190-17",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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