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1821698077 NPI number — GAYLE MARIE MORTENSEN APRN

NPI Number: 1821698077
Health Care Provider/Practitioner: GAYLE MARIE MORTENSEN APRN

Information about “1821698077” NPI (GAYLE MARIE MORTENSEN APRN) exists in 1821698077 in HTML format HTML  |  1821698077 in plain Text format TXT  |  1821698077 in PDF (Portable Document Format) PDF  |  1821698077 in an XML format XML  formats.

NPI Number : 1821698077 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1821698077",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MORTENSEN",
    "FirstName": "GAYLE",
    "MiddleName": "MARIE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "APRN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1619 HILLSBORO DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAYTON",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84040-8250",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-865-5450",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1619 HILLSBORO DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAYTON",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84040-8250",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-865-5450",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/27/2020",
    "LastUpdateDate": "11/19/2020",
    "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": "363L00000X",
        "TaxonomyName": "Nurse Practitioner",
        "LicenseNumber": "279741-4405",
        "LicenseNumberStateCode": "UT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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