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1669952495 NPI number — AVITUS MAROBA ITOE

NPI Number: 1669952495
Health Care Provider/Practitioner: AVITUS MAROBA ITOE

Information about “1669952495” NPI (AVITUS MAROBA ITOE) exists in 1669952495 in HTML format HTML  |  1669952495 in plain Text format TXT  |  1669952495 in PDF (Portable Document Format) PDF  |  1669952495 in an XML format XML  formats.

NPI Number : 1669952495 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669952495",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ITOE",
    "FirstName": "AVITUS",
    "MiddleName": "MAROBA",
    "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": "3632 LUTON CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28262-2648",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-974-1354",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4155 FERNCREEK DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAYETTEVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28314-2581",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "910-425-5999",
    "PracticeLocationAddressFaxNumber": "910-920-4313",
    "EnumerationDate": "08/21/2018",
    "LastUpdateDate": "08/21/2018",
    "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": "5010863",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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