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1790392280 NPI number — PAULINA MORA CRNA

NPI Number: 1790392280
Health Care Provider/Practitioner: PAULINA MORA CRNA

Information about “1790392280” NPI (PAULINA MORA CRNA) exists in 1790392280 in HTML format HTML  |  1790392280 in plain Text format TXT  |  1790392280 in PDF (Portable Document Format) PDF  |  1790392280 in an XML format XML  formats.

NPI Number : 1790392280 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790392280",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MORA",
    "FirstName": "PAULINA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRNA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "103 S 23RD ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TERRE HAUTE",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "47803-1831",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "312-813-0338",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2737 S 7TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TERRE HAUTE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47802-3509",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "812-231-4608",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/28/2020",
    "LastUpdateDate": "09/28/2020",
    "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": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "041406983",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "135409",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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