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1881835056 NPI number — TRACEY ANN GLENN ARNP

NPI Number: 1881835056
Health Care Provider/Practitioner: TRACEY ANN GLENN ARNP

Information about “1881835056” NPI (TRACEY ANN GLENN ARNP) exists in 1881835056 in HTML format HTML  |  1881835056 in plain Text format TXT  |  1881835056 in PDF (Portable Document Format) PDF  |  1881835056 in an XML format XML  formats.

NPI Number : 1881835056 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1881835056",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GLENN",
    "FirstName": "TRACEY",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ARNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1305 HAINS AVENUE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RICHLAND",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "99354",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "509-366-6107",
    "MailingAddressFaxNumber": "509-946-7162",
    "FirstLinePracticeLocationAddress": "1305 HAINS AVENUE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RICHLAND",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "99354",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "509-366-6107",
    "PracticeLocationAddressFaxNumber": "509-946-7162",
    "EnumerationDate": "03/17/2009",
    "LastUpdateDate": "03/05/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "02/08/2019",
    "NPIReactivationDate": "03/05/2019",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "RN00152763",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "AP30008011",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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