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1942784962 NPI number — KATIE MAE NELSEN PA-C

NPI Number: 1942784962
Health Care Provider/Practitioner: KATIE MAE NELSEN PA-C

Information about “1942784962” NPI (KATIE MAE NELSEN PA-C) exists in 1942784962 in HTML format HTML  |  1942784962 in plain Text format TXT  |  1942784962 in PDF (Portable Document Format) PDF  |  1942784962 in an XML format XML  formats.

NPI Number : 1942784962 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942784962",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NELSEN",
    "FirstName": "KATIE",
    "MiddleName": "MAE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1969 E MEADOW DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALT LAKE CITY",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84121-2959",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "951-818-2989",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3556 W 9800 S STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTH JORDAN",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84095-3221",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-567-9780",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/17/2018",
    "LastUpdateDate": "11/29/2018",
    "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": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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