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1780834747 NPI number — ERICA P CRISS APN

NPI Number: 1780834747
Health Care Provider/Practitioner: ERICA P CRISS APN

Information about “1780834747” NPI (ERICA P CRISS APN) exists in 1780834747 in HTML format HTML  |  1780834747 in plain Text format TXT  |  1780834747 in PDF (Portable Document Format) PDF  |  1780834747 in an XML format XML  formats.

NPI Number : 1780834747 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780834747",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CRISS",
    "FirstName": "ERICA",
    "MiddleName": "P",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "APN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6121 N HANLEY RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BERKELEY",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63134-2003",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-615-0600",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5 LUGWIG DRIVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAIRVIEW HEIGHTS",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62208",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "618-397-9000",
    "PracticeLocationAddressFaxNumber": "618-397-9003",
    "EnumerationDate": "09/26/2008",
    "LastUpdateDate": "05/10/2018",
    "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": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "2010036627",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "209007255",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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