NPI Code Detail JSON Logo

1689280802 NPI number — BERKLEY PETERSEN GREENE AUD

NPI Number: 1689280802
Health Care Provider/Practitioner: BERKLEY PETERSEN GREENE AUD

Information about “1689280802” NPI (BERKLEY PETERSEN GREENE AUD) exists in 1689280802 in HTML format HTML  |  1689280802 in plain Text format TXT  |  1689280802 in PDF (Portable Document Format) PDF  |  1689280802 in an XML format XML  formats.

NPI Number : 1689280802 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689280802",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GREENE",
    "FirstName": "BERKLEY",
    "MiddleName": "PETERSEN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "AUD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PETERSEN",
    "OtherFirstName": "BERKLEY",
    "OtherMiddleName": "JUNE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "AUD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2295 HENRY TECKLENBURG DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLESTON",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29414-7801",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "843-766-7103",
    "MailingAddressFaxNumber": "843-377-4629",
    "FirstLinePracticeLocationAddress": "2295 HENRY TECKLENBURG DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLESTON",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29414-7801",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-766-7103",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/22/2020",
    "LastUpdateDate": "11/21/2025",
    "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": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "3532",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "2201001869",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "8037",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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