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1629899299 NPI number — KAITLIN O'DEA

NPI Number: 1629899299
Health Care Provider/Practitioner: KAITLIN O'DEA

Information about “1629899299” NPI (KAITLIN O'DEA) exists in 1629899299 in HTML format HTML  |  1629899299 in plain Text format TXT  |  1629899299 in PDF (Portable Document Format) PDF  |  1629899299 in an XML format XML  formats.

NPI Number : 1629899299 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629899299",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "O'DEA",
    "FirstName": "KAITLIN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "29373 NETWORK PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60673-1293",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-390-5900",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1675 W DEMPSTER ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PARK RIDGE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60068-1110",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-723-5313",
    "PracticeLocationAddressFaxNumber": "847-723-2325",
    "EnumerationDate": "10/17/2024",
    "LastUpdateDate": "11/21/2024",
    "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": "363LP0222X",
        "TaxonomyName": "Critical Care Pediatric Nurse Practitioner",
        "LicenseNumber": "209.030328",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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