NPI Code Detail JSON Logo

1700250453 NPI number — VANCE ANDERSON

NPI Number: 1700250453
Health Care Provider/Practitioner: VANCE ANDERSON

Information about “1700250453” NPI (VANCE ANDERSON) exists in 1700250453 in HTML format HTML  |  1700250453 in plain Text format TXT  |  1700250453 in PDF (Portable Document Format) PDF  |  1700250453 in an XML format XML  formats.

NPI Number : 1700250453 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700250453",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ANDERSON",
    "FirstName": "VANCE",
    "MiddleName": null,
    "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": "4763 BRINKER AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OGDEN",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84403-4242",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-979-3462",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "269 W 3300 S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OGDEN",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84401-3845",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-393-2742",
    "PracticeLocationAddressFaxNumber": "801-393-2184",
    "EnumerationDate": "11/18/2015",
    "LastUpdateDate": "11/18/2015",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "261721-3501",
        "LicenseNumberStateCode": "UT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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