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1811259955 NPI number — SUSANNE RENEE OWENS CRNA

NPI Number: 1811259955
Health Care Provider/Practitioner: SUSANNE RENEE OWENS CRNA

Information about “1811259955” NPI (SUSANNE RENEE OWENS CRNA) exists in 1811259955 in HTML format HTML  |  1811259955 in plain Text format TXT  |  1811259955 in PDF (Portable Document Format) PDF  |  1811259955 in an XML format XML  formats.

NPI Number : 1811259955 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811259955",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "OWENS",
    "FirstName": "SUSANNE",
    "MiddleName": "RENEE",
    "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": "6000 HOSPITAL DR",
    "SecondLineMailingAddress": "P O BOX 551",
    "MailingAddressCityName": "HANNIBAL",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63401-6887",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "573-248-5115",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "450 E SIGLER AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MEMPHIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63555-1726",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "660-465-8511",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/14/2012",
    "LastUpdateDate": "01/03/2024",
    "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": "367500000X",
        "TaxonomyName": "Certified Registered Nurse Anesthetist",
        "LicenseNumber": "146012",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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