NPI Code Detail JSON Logo

1689017261 NPI number — CORISSA JULIE FLAGG RDH

NPI Number: 1689017261
Health Care Provider/Practitioner: CORISSA JULIE FLAGG RDH

Information about “1689017261” NPI (CORISSA JULIE FLAGG RDH) exists in 1689017261 in HTML format HTML  |  1689017261 in plain Text format TXT  |  1689017261 in PDF (Portable Document Format) PDF  |  1689017261 in an XML format XML  formats.

NPI Number : 1689017261 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689017261",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FLAGG",
    "FirstName": "CORISSA",
    "MiddleName": "JULIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RDH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11321 IBIS ST NW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COON RAPIDS",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55433-3750",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "763-238-2136",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1700 HIGHWAY 36 W",
    "SecondLinePracticeLocationAddress": "STE 860",
    "PracticeLocationAddressCityName": "SAINT PAUL",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55113-4034",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-778-9911",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/12/2013",
    "LastUpdateDate": "04/12/2013",
    "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": "124Q00000X",
        "TaxonomyName": "Dental Hygienist",
        "LicenseNumber": "H8180",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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