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1922963156 NPI number — MARTHA ELLERMAN

NPI Number: 1922963156
Health Care Provider/Practitioner: MARTHA ELLERMAN

Information about “1922963156” NPI (MARTHA ELLERMAN) exists in 1922963156 in HTML format HTML  |  1922963156 in plain Text format TXT  |  1922963156 in PDF (Portable Document Format) PDF  |  1922963156 in an XML format XML  formats.

NPI Number : 1922963156 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922963156",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELLERMAN",
    "FirstName": "MARTHA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BRUCE",
    "OtherFirstName": "MARTHA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "102 S WINOOSKI AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BURLINGTON",
    "MailingAddressStateName": "VT",
    "MailingAddressPostalCode": "05401-7406",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "802-488-6920",
    "MailingAddressFaxNumber": "802-488-6919",
    "FirstLinePracticeLocationAddress": "1138 PINE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BURLINGTON",
    "PracticeLocationAddressStateName": "VT",
    "PracticeLocationAddressPostalCode": "05401-5353",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "802-488-6000",
    "PracticeLocationAddressFaxNumber": "802-488-6919",
    "EnumerationDate": "12/19/2025",
    "LastUpdateDate": "12/19/2025",
    "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": "390200000X",
        "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
        "LicenseNumber": "097.0135873",
        "LicenseNumberStateCode": "VT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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