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1811687890 NPI number — MOUNTAIN MEDICINE INTEGRATIVE WELLNESS

NPI Number: 1811687890
Health Care Provider/Practitioner: MOUNTAIN MEDICINE INTEGRATIVE WELLNESS

Information about “1811687890” NPI (MOUNTAIN MEDICINE INTEGRATIVE WELLNESS) exists in 1811687890 in HTML format HTML  |  1811687890 in plain Text format TXT  |  1811687890 in PDF (Portable Document Format) PDF  |  1811687890 in an XML format XML  formats.

NPI Number : 1811687890 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811687890",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MOUNTAIN MEDICINE INTEGRATIVE WELLNESS",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "569 PEAVINE FIRETOWER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CROSSVILLE",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38571-0997",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "931-710-5483",
    "MailingAddressFaxNumber": "931-810-9272",
    "FirstLinePracticeLocationAddress": "58 W FIRST ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CROSSVILLE",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38555-4443",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "931-710-5483",
    "PracticeLocationAddressFaxNumber": "931-810-9272",
    "EnumerationDate": "05/11/2023",
    "LastUpdateDate": "01/31/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CUVA",
    "AuthorizedOfficialFirstName": "DALE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "NURSE PRACTITIONER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "423-220-9409",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261Q00000X",
          "TaxonomyName": "Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "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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