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1841741030 NPI number — EDWARD JIM VREDENBURGH III RN

NPI Number: 1841741030
Health Care Provider/Practitioner: EDWARD JIM VREDENBURGH III RN

Information about “1841741030” NPI (EDWARD JIM VREDENBURGH III RN) exists in 1841741030 in HTML format HTML  |  1841741030 in plain Text format TXT  |  1841741030 in PDF (Portable Document Format) PDF  |  1841741030 in an XML format XML  formats.

NPI Number : 1841741030 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1841741030",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VREDENBURGH",
    "FirstName": "EDWARD",
    "MiddleName": "JIM",
    "NamePrefix": "MR.",
    "NameSuffix": "III",
    "Credential": "RN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11133 DUNN RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63136-6163",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-653-5000",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "11133 DUNN RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63136-6163",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-653-5000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/22/2016",
    "LastUpdateDate": "06/28/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "2018037132",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "2001004428",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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