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1982690467 NPI number — TRACEE JEAN MARTIN KARLSON

NPI Number: 1982690467
Health Care Provider/Practitioner: TRACEE JEAN MARTIN KARLSON

Information about “1982690467” NPI (TRACEE JEAN MARTIN KARLSON) exists in 1982690467 in HTML format HTML  |  1982690467 in plain Text format TXT  |  1982690467 in PDF (Portable Document Format) PDF  |  1982690467 in an XML format XML  formats.

NPI Number : 1982690467 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1982690467",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KARLSON",
    "FirstName": "TRACEE",
    "MiddleName": "JEAN MARTIN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MARTIN",
    "OtherFirstName": "TRACEE",
    "OtherMiddleName": "J",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6028 TIGER TAIL DR SW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OLYMPIA",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98512-2141",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-584-4556",
    "MailingAddressFaxNumber": "360-251-0011",
    "FirstLinePracticeLocationAddress": "1802 BLACK LAKE BLVD SW STE 103",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OLYMPIA",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98512-5634",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-584-4556",
    "PracticeLocationAddressFaxNumber": "360-251-0011",
    "EnumerationDate": "09/21/2005",
    "LastUpdateDate": "01/09/2023",
    "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": "PT00007810",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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