1912472952 NPI number — KRISTEN NICOLE SCHROEDER BSN-RN, CHES, CDE

NPI Number: 1912472952
Health Care Provider/Practitioner: KRISTEN NICOLE SCHROEDER BSN-RN, CHES, CDE

NPI Number : 1912472952 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912472952",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SCHROEDER",
    "FirstName": "KRISTEN",
    "MiddleName": "NICOLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "BSN-RN, CHES, CDE",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2739 NE 15TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "POMPANO BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33062-8261",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-270-2818",
    "MailingAddressFaxNumber": "954-771-7952",
    "FirstLinePracticeLocationAddress": "4725 N FEDERAL HWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT LAUDERDALE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33308-4603",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-771-2381",
    "PracticeLocationAddressFaxNumber": "954-771-7952",
    "EnumerationDate": "10/05/2018",
    "LastUpdateDate": "10/05/2018",
    "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": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "RN9391982",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WD0400X",
          "TaxonomyName": "Diabetes Educator Registered Nurse",
          "LicenseNumber": "RN9391982",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}