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1649719816 NPI number — LISA RENEE STALEY NP

NPI Number: 1649719816
Health Care Provider/Practitioner: LISA RENEE STALEY NP

Information about “1649719816” NPI (LISA RENEE STALEY NP) exists in 1649719816 in HTML format HTML  |  1649719816 in plain Text format TXT  |  1649719816 in PDF (Portable Document Format) PDF  |  1649719816 in an XML format XML  formats.

NPI Number : 1649719816 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649719816",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "STALEY",
    "FirstName": "LISA",
    "MiddleName": "RENEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LEE",
    "OtherFirstName": "LISA",
    "OtherMiddleName": "RENEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LPN",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6435 W JEFFERSON BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT WAYNE",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46804-6203",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "260-344-4035",
    "MailingAddressFaxNumber": "260-969-9272",
    "FirstLinePracticeLocationAddress": "800 W MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLDWATER",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45828-1613",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "260-344-4035",
    "PracticeLocationAddressFaxNumber": "260-969-9272",
    "EnumerationDate": "02/21/2017",
    "LastUpdateDate": "03/02/2017",
    "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": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "APRN.CNP.020584",
        "LicenseNumberStateCode": "OH",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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