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1861910721 NPI number — MRS. LETITIA SUSAN EDGELL

NPI Number: 1861910721
Health Care Provider/Practitioner: MRS. LETITIA SUSAN EDGELL

Information about “1861910721” NPI (MRS. LETITIA SUSAN EDGELL) exists in 1861910721 in HTML format HTML  |  1861910721 in plain Text format TXT  |  1861910721 in PDF (Portable Document Format) PDF  |  1861910721 in an XML format XML  formats.

NPI Number : 1861910721 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861910721",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EDGELL",
    "FirstName": "LETITIA",
    "MiddleName": "SUSAN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FORSMAN",
    "OtherFirstName": "LETITIA",
    "OtherMiddleName": "SUSAN",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "503 LAWNDALE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WOODSTOCK",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60098-4030",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "815-527-7624",
    "MailingAddressFaxNumber": "815-337-2032",
    "FirstLinePracticeLocationAddress": "503 LAWNDALE AVE.",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WOODSTOCK",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60098",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "815-527-7624",
    "PracticeLocationAddressFaxNumber": "815-337-2032",
    "EnumerationDate": "08/31/2017",
    "LastUpdateDate": "07/21/2022",
    "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": "374700000X",
        "TaxonomyName": "Technician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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