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1689070872 NPI number — MR. STEVE GWALTNEY JR.

NPI Number: 1689070872
Health Care Provider/Practitioner: MR. STEVE GWALTNEY JR.

Information about “1689070872” NPI (MR. STEVE GWALTNEY JR.) exists in 1689070872 in HTML format HTML  |  1689070872 in plain Text format TXT  |  1689070872 in PDF (Portable Document Format) PDF  |  1689070872 in an XML format XML  formats.

NPI Number : 1689070872 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689070872",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GWALTNEY",
    "FirstName": "STEVE",
    "MiddleName": null,
    "NamePrefix": "MR.",
    "NameSuffix": "JR.",
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2401 HAY RAKE CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HERNDON",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "20171-4328",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-537-4234",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1701 N GEORGE MASON DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ARLINGTON",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22205-3610",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "703-558-6173",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/14/2014",
    "LastUpdateDate": "07/17/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "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": "0024172242",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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