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1659731636 NPI number — SAMANTHA R. IRWIN CRNA

NPI Number: 1659731636
Health Care Provider/Practitioner: SAMANTHA R. IRWIN CRNA

Information about “1659731636” NPI (SAMANTHA R. IRWIN CRNA) exists in 1659731636 in HTML format HTML  |  1659731636 in plain Text format TXT  |  1659731636 in PDF (Portable Document Format) PDF  |  1659731636 in an XML format XML  formats.

NPI Number : 1659731636 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659731636",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "IRWIN",
    "FirstName": "SAMANTHA",
    "MiddleName": "R.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRNA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "105 W STONE DR",
    "SecondLineMailingAddress": "SUITE 6A",
    "MailingAddressCityName": "KINGSPORT",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37660-3365",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "423-408-7220",
    "MailingAddressFaxNumber": "423-408-7405",
    "FirstLinePracticeLocationAddress": "1 MEDICAL PARK BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BRISTOL",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37620-7430",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "423-844-2686",
    "PracticeLocationAddressFaxNumber": "423-844-2688",
    "EnumerationDate": "03/03/2016",
    "LastUpdateDate": "03/31/2016",
    "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": "367500000X",
        "TaxonomyName": "Certified Registered Nurse Anesthetist",
        "LicenseNumber": "20904",
        "LicenseNumberStateCode": "TN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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