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1679767255 NPI number — MARY JANE SIRNA PTA

NPI Number: 1679767255
Health Care Provider/Practitioner: MARY JANE SIRNA PTA

Information about “1679767255” NPI (MARY JANE SIRNA PTA) exists in 1679767255 in HTML format HTML  |  1679767255 in plain Text format TXT  |  1679767255 in PDF (Portable Document Format) PDF  |  1679767255 in an XML format XML  formats.

NPI Number : 1679767255 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679767255",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SIRNA",
    "FirstName": "MARY",
    "MiddleName": "JANE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PTA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5021 S CEDAR CREST AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "INDEPENDENCE",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "64055-6934",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "816-478-8443",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10300 W 103RD ST",
    "SecondLinePracticeLocationAddress": "SUITE 300",
    "PracticeLocationAddressCityName": "OVERLAND PARK",
    "PracticeLocationAddressStateName": "KS",
    "PracticeLocationAddressPostalCode": "66214-2642",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "913-894-1910",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/28/2007",
    "LastUpdateDate": "08/28/2007",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "115713",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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