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1689327314 NPI number — MARICETA ANN GOVAN

NPI Number: 1689327314
Health Care Provider/Practitioner: MARICETA ANN GOVAN

Information about “1689327314” NPI (MARICETA ANN GOVAN) exists in 1689327314 in HTML format HTML  |  1689327314 in plain Text format TXT  |  1689327314 in PDF (Portable Document Format) PDF  |  1689327314 in an XML format XML  formats.

NPI Number : 1689327314 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689327314",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOVAN",
    "FirstName": "MARICETA",
    "MiddleName": "ANN",
    "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": "333 WEST BROWN DEER RD",
    "SecondLineMailingAddress": "SUITEG-507",
    "MailingAddressCityName": "MILWAUKEE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53217",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "414-210-9959",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "333 W BROWN DEER RD # 507",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MILWAUKEE",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53217-2372",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "414-210-9959",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/02/2022",
    "LastUpdateDate": "02/02/2022",
    "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": "172A00000X",
        "TaxonomyName": "Driver",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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