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1831554682 NPI number — BRETTNEY DAUGHERTY N.P., D.N.P.

NPI Number: 1831554682
Health Care Provider/Practitioner: BRETTNEY DAUGHERTY N.P., D.N.P.

Information about “1831554682” NPI (BRETTNEY DAUGHERTY N.P., D.N.P.) exists in 1831554682 in HTML format HTML  |  1831554682 in plain Text format TXT  |  1831554682 in PDF (Portable Document Format) PDF  |  1831554682 in an XML format XML  formats.

NPI Number : 1831554682 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1831554682",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAUGHERTY",
    "FirstName": "BRETTNEY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "N.P., D.N.P.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "648 SUNFISH WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORT HUENEME",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "93041-3504",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "661-747-3788",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1711 OCEAN PARK BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SANTA MONICA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90405-4901",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-450-2191",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/22/2015",
    "LastUpdateDate": "10/10/2019",
    "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": "363LP2300X",
        "TaxonomyName": "Primary Care Nurse Practitioner",
        "LicenseNumber": "95003505",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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