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1760433577 NPI number — JUDY L JEROME CGNP

NPI Number: 1760433577
Health Care Provider/Practitioner: JUDY L JEROME CGNP

Information about “1760433577” NPI (JUDY L JEROME CGNP) exists in 1760433577 in HTML format HTML  |  1760433577 in plain Text format TXT  |  1760433577 in PDF (Portable Document Format) PDF  |  1760433577 in an XML format XML  formats.

NPI Number : 1760433577 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760433577",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JEROME",
    "FirstName": "JUDY",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CGNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "310 N. MAIN STREET",
    "SecondLineMailingAddress": "SUITE 301",
    "MailingAddressCityName": "CHELSEA",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48118-1807",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "734-222-8200",
    "MailingAddressFaxNumber": "734-222-8202",
    "FirstLinePracticeLocationAddress": "829 N CENTER AVE",
    "SecondLinePracticeLocationAddress": "SUITE 140",
    "PracticeLocationAddressCityName": "GAYLORD",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49735-1595",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "989-731-7870",
    "PracticeLocationAddressFaxNumber": "989-731-7837",
    "EnumerationDate": "05/15/2006",
    "LastUpdateDate": "03/07/2023",
    "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": "363LG0600X",
        "TaxonomyName": "Gerontology Nurse Practitioner",
        "LicenseNumber": "4704120506",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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