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1790975043 NPI number — PAMELA JOY CORNELLA NP

NPI Number: 1790975043
Health Care Provider/Practitioner: PAMELA JOY CORNELLA NP

Information about “1790975043” NPI (PAMELA JOY CORNELLA NP) exists in 1790975043 in HTML format HTML  |  1790975043 in plain Text format TXT  |  1790975043 in PDF (Portable Document Format) PDF  |  1790975043 in an XML format XML  formats.

NPI Number : 1790975043 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790975043",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CORNELLA",
    "FirstName": "PAMELA",
    "MiddleName": "JOY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1925 E ORMAN AVE",
    "SecondLineMailingAddress": "A640",
    "MailingAddressCityName": "PUEBLO",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "81004-3537",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "719-564-1544",
    "MailingAddressFaxNumber": "719-565-2657",
    "FirstLinePracticeLocationAddress": "1925 E ORMAN AVE",
    "SecondLinePracticeLocationAddress": "A640",
    "PracticeLocationAddressCityName": "PUEBLO",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "81004-3537",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "719-564-1544",
    "PracticeLocationAddressFaxNumber": "719-565-2657",
    "EnumerationDate": "08/01/2007",
    "LastUpdateDate": "08/01/2007",
    "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": "363L00000X",
        "TaxonomyName": "Nurse Practitioner",
        "LicenseNumber": "91303",
        "LicenseNumberStateCode": "CO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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