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1871719187 NPI number — REVE PURISIMA SHIELDS MD

NPI Number: 1871719187
Health Care Provider/Practitioner: REVE PURISIMA SHIELDS MD

Information about “1871719187” NPI (REVE PURISIMA SHIELDS MD) exists in 1871719187 in HTML format HTML  |  1871719187 in plain Text format TXT  |  1871719187 in PDF (Portable Document Format) PDF  |  1871719187 in an XML format XML  formats.

NPI Number : 1871719187 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1871719187",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHIELDS",
    "FirstName": "REVE",
    "MiddleName": "PURISIMA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PURISIMA",
    "OtherFirstName": "REVE",
    "OtherMiddleName": "GAMBA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "101 COLUMBIAN ST",
    "SecondLineMailingAddress": "SUITE 330",
    "MailingAddressCityName": "SOUTH WEYMOUTH",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02190-1601",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "781-624-4690",
    "MailingAddressFaxNumber": "401-624-2610",
    "FirstLinePracticeLocationAddress": "101 COLUMBIAN ST",
    "SecondLinePracticeLocationAddress": "SUITE 330",
    "PracticeLocationAddressCityName": "SOUTH WEYMOUTH",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "02190-1601",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "781-624-4690",
    "PracticeLocationAddressFaxNumber": "401-624-2610",
    "EnumerationDate": "04/17/2007",
    "LastUpdateDate": "11/02/2018",
    "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": "207RH0003X",
        "TaxonomyName": "Hematology & Oncology Physician",
        "LicenseNumber": "247435",
        "LicenseNumberStateCode": "MA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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