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1770557993 NPI number — BROOKE T PACKARD PA

NPI Number: 1770557993
Health Care Provider/Practitioner: BROOKE T PACKARD PA

Information about “1770557993” NPI (BROOKE T PACKARD PA) exists in 1770557993 in HTML format HTML  |  1770557993 in plain Text format TXT  |  1770557993 in PDF (Portable Document Format) PDF  |  1770557993 in an XML format XML  formats.

NPI Number : 1770557993 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770557993",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PACKARD",
    "FirstName": "BROOKE",
    "MiddleName": "T",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "TIETSORT",
    "OtherFirstName": "BROOKE",
    "OtherMiddleName": "ANNE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "7851 S ELATI ST",
    "SecondLineMailingAddress": "SUITE 202",
    "MailingAddressCityName": "LITTLETON",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80120-8080",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "303-759-0854",
    "MailingAddressFaxNumber": "303-759-0864",
    "FirstLinePracticeLocationAddress": "4231 W 16TH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DENVER",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80204-1335",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "303-629-3721",
    "PracticeLocationAddressFaxNumber": "303-629-2192",
    "EnumerationDate": "02/14/2006",
    "LastUpdateDate": "01/31/2025",
    "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": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA.0002000",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "2000",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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