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1942617188 NPI number — KIERAN LYSSA NASHAN

NPI Number: 1942617188
Health Care Provider/Practitioner: KIERAN LYSSA NASHAN

Information about “1942617188” NPI (KIERAN LYSSA NASHAN) exists in 1942617188 in HTML format HTML  |  1942617188 in plain Text format TXT  |  1942617188 in PDF (Portable Document Format) PDF  |  1942617188 in an XML format XML  formats.

NPI Number : 1942617188 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942617188",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NASHAN",
    "FirstName": "KIERAN",
    "MiddleName": "LYSSA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCKINNELL",
    "OtherFirstName": "KIERAN",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "16083 SW UPPER BOONES FERRY RD",
    "SecondLineMailingAddress": "SUITE 300",
    "MailingAddressCityName": "TIGARD",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97224-7736",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "800-219-8835",
    "MailingAddressFaxNumber": "503-639-9699",
    "FirstLinePracticeLocationAddress": "104 CENTENNIAL DR STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LIVINGSTON",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59047-8101",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-222-0366",
    "PracticeLocationAddressFaxNumber": "406-222-0366",
    "EnumerationDate": "07/21/2014",
    "LastUpdateDate": "04/25/2024",
    "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": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "PTP-PT-LIC-9425",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "60480124",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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