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1720630197 NPI number — JAMES DEAN STALIANS AGNP

NPI Number: 1720630197
Health Care Provider/Practitioner: JAMES DEAN STALIANS AGNP

Information about “1720630197” NPI (JAMES DEAN STALIANS AGNP) exists in 1720630197 in HTML format HTML  |  1720630197 in plain Text format TXT  |  1720630197 in PDF (Portable Document Format) PDF  |  1720630197 in an XML format XML  formats.

NPI Number : 1720630197 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720630197",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "STALIANS",
    "FirstName": "JAMES",
    "MiddleName": "DEAN",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "AGNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "STALIANS",
    "OtherFirstName": "JIM",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "AGNP",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "737 W CHILDS AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MERCED",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95341-6805",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "866-682-4842",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1540 FLORIDA AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MODESTO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95350-4430",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "866-682-4842",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/15/2019",
    "LastUpdateDate": "07/15/2019",
    "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": "163WG0600X",
          "TaxonomyName": "Gerontology Registered Nurse",
          "LicenseNumber": "452145",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LA2200X",
          "TaxonomyName": "Adult Health Nurse Practitioner",
          "LicenseNumber": "95010123",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LG0600X",
          "TaxonomyName": "Gerontology Nurse Practitioner",
          "LicenseNumber": "95010123",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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