NPI Code Detail JSON Logo

1760052443 NPI number — NATHAN L HOLLENBECK R EEG T

NPI Number: 1760052443
Health Care Provider/Practitioner: NATHAN L HOLLENBECK R EEG T

Information about “1760052443” NPI (NATHAN L HOLLENBECK R EEG T) exists in 1760052443 in HTML format HTML  |  1760052443 in plain Text format TXT  |  1760052443 in PDF (Portable Document Format) PDF  |  1760052443 in an XML format XML  formats.

NPI Number : 1760052443 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760052443",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HOLLENBECK",
    "FirstName": "NATHAN",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "R EEG T",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "903 GARLOCK ST S",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALEM",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97302-6022",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-269-2621",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3270 LIBERTY RD S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SALEM",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97302-4560",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-269-2621",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/25/2021",
    "LastUpdateDate": "06/25/2021",
    "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": "133N00000X",
          "TaxonomyName": "Nutritionist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133NN1002X",
          "TaxonomyName": "Nutrition Education Nutritionist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175F00000X",
          "TaxonomyName": "Naturopath",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "246ZE0500X",
          "TaxonomyName": "EEG Specialist/Technologist",
          "LicenseNumber": "5811",
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "293D00000X",
          "TaxonomyName": "Physiological Laboratory",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "374K00000X",
          "TaxonomyName": "Religious Nonmedical Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "246ZE0600X",
          "TaxonomyName": "Electroneurodiagnostic Specialist/Technologist",
          "LicenseNumber": "5811",
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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