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1710696919 NPI number — SHJADE CAROLINA SMITH APRN, CNP

NPI Number: 1710696919
Health Care Provider/Practitioner: SHJADE CAROLINA SMITH APRN, CNP

Information about “1710696919” NPI (SHJADE CAROLINA SMITH APRN, CNP) exists in 1710696919 in HTML format HTML  |  1710696919 in plain Text format TXT  |  1710696919 in PDF (Portable Document Format) PDF  |  1710696919 in an XML format XML  formats.

NPI Number : 1710696919 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710696919",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SMITH",
    "FirstName": "SHJADE",
    "MiddleName": "CAROLINA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "APRN, CNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HEUTZENROEDER",
    "OtherFirstName": "SHJADE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2333 W 57TH ST STE 103",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SIOUX FALLS",
    "MailingAddressStateName": "SD",
    "MailingAddressPostalCode": "57108-5054",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "605-271-5640",
    "MailingAddressFaxNumber": "605-653-4415",
    "FirstLinePracticeLocationAddress": "300 W MAPLE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TEA",
    "PracticeLocationAddressStateName": "SD",
    "PracticeLocationAddressPostalCode": "57064-2300",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "605-261-4103",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/16/2022",
    "LastUpdateDate": "11/05/2025",
    "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": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "10387",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "CP002571",
          "LicenseNumberStateCode": "SD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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