1760748446 NPI number — KRYSTAL W NIZAR M.D., PH.D.

NPI Number: 1760748446
Health Care Provider/Practitioner: KRYSTAL W NIZAR M.D., PH.D.

NPI Number : 1760748446 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760748446",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NIZAR",
    "FirstName": "KRYSTAL",
    "MiddleName": "W",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D., PH.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CHIAO",
    "OtherFirstName": "KRYSTAL",
    "OtherMiddleName": "W",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "450 HIGHWAY 1 W # 115",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "IOWA CITY",
    "MailingAddressStateName": "IA",
    "MailingAddressPostalCode": "52246-4204",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "319-435-1720",
    "MailingAddressFaxNumber": "620-670-8407",
    "FirstLinePracticeLocationAddress": "450 HIGHWAY 1 W # 115",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "IOWA CITY",
    "PracticeLocationAddressStateName": "IA",
    "PracticeLocationAddressPostalCode": "52246-4204",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "319-435-1720",
    "PracticeLocationAddressFaxNumber": "620-670-8407",
    "EnumerationDate": "04/06/2012",
    "LastUpdateDate": "09/08/2020",
    "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": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "A126783",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "MD-45892",
          "LicenseNumberStateCode": "IA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}