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1780854760 NPI number — STEPHANIE ANN PETERSON PMHNP

NPI Number: 1780854760
Health Care Provider/Practitioner: STEPHANIE ANN PETERSON PMHNP

Information about “1780854760” NPI (STEPHANIE ANN PETERSON PMHNP) exists in 1780854760 in HTML format HTML  |  1780854760 in plain Text format TXT  |  1780854760 in PDF (Portable Document Format) PDF  |  1780854760 in an XML format XML  formats.

NPI Number : 1780854760 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780854760",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PETERSON",
    "FirstName": "STEPHANIE",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PMHNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BIXBY",
    "OtherFirstName": "STEPHANIE",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "859 WASHINGTON ST # 203",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RED BLUFF",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "96080-2704",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "530-262-7025",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "21449 ROUGHOUT RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "REDDING",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "96003-8209",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "530-262-7025",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/06/2008",
    "LastUpdateDate": "07/21/2022",
    "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": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "95020435",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163WP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Registered Nurse",
          "LicenseNumber": "716439",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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