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1912149170 NPI number — KRISTEN ANN KLEMENT TASSONE M.D.

NPI Number: 1912149170
Health Care Provider/Practitioner: KRISTEN ANN KLEMENT TASSONE M.D.

Information about “1912149170” NPI (KRISTEN ANN KLEMENT TASSONE M.D.) exists in 1912149170 in HTML format HTML  |  1912149170 in plain Text format TXT  |  1912149170 in PDF (Portable Document Format) PDF  |  1912149170 in an XML format XML  formats.

NPI Number : 1912149170 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912149170",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KLEMENT TASSONE",
    "FirstName": "KRISTEN",
    "MiddleName": "ANN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HUDAK",
    "OtherFirstName": "KRISTEN",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.D.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1155 N MAYFAIR RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WAUWATOSA",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53226-3462",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "414-955-4263",
    "MailingAddressFaxNumber": "414-955-6286",
    "FirstLinePracticeLocationAddress": "1155 N MAYFAIR RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WAUWATOSA",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53226-3462",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "414-955-4263",
    "PracticeLocationAddressFaxNumber": "414-955-6286",
    "EnumerationDate": "04/01/2009",
    "LastUpdateDate": "02/22/2024",
    "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": "2086S0122X",
        "TaxonomyName": "Plastic and Reconstructive Surgery Physician",
        "LicenseNumber": "54773-20",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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