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1720481963 NPI number — VICTORIA REXRODE NP

NPI Number: 1720481963
Health Care Provider/Practitioner: VICTORIA REXRODE NP

Information about “1720481963” NPI (VICTORIA REXRODE NP) exists in 1720481963 in HTML format HTML  |  1720481963 in plain Text format TXT  |  1720481963 in PDF (Portable Document Format) PDF  |  1720481963 in an XML format XML  formats.

NPI Number : 1720481963 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720481963",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "REXRODE",
    "FirstName": "VICTORIA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "REXRODE-WHITE",
    "OtherFirstName": "VICTORIA",
    "OtherMiddleName": "BREANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "NP",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "10 MADISON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GLENS FALLS",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "12801-3052",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "518-321-8359",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "175 BROAD ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GLENS FALLS",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "12801-4119",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "518-321-8359",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/02/2014",
    "LastUpdateDate": "01/03/2026",
    "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": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "349652",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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