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1851108773 NPI number — EVANN RAE ROSEBROUGH CLC

NPI Number: 1851108773
Health Care Provider/Practitioner: EVANN RAE ROSEBROUGH CLC

Information about “1851108773” NPI (EVANN RAE ROSEBROUGH CLC) exists in 1851108773 in HTML format HTML  |  1851108773 in plain Text format TXT  |  1851108773 in PDF (Portable Document Format) PDF  |  1851108773 in an XML format XML  formats.

NPI Number : 1851108773 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1851108773",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROSEBROUGH",
    "FirstName": "EVANN",
    "MiddleName": "RAE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CLC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7249 RED MAPLE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ZIONSVILLE",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46077-7759",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "317-503-6766",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8111 TOWNSHIP LINE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INDIANAPOLIS",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46260-2479",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "317-415-8111",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/13/2024",
    "LastUpdateDate": "12/13/2024",
    "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": "174N00000X",
        "TaxonomyName": "Lactation Consultant (Non-RN)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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