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1992970552 NPI number — LISA LINN SANTO DOMINGO CRNP-PEDIATRICS

NPI Number: 1992970552
Health Care Provider/Practitioner: LISA LINN SANTO DOMINGO CRNP-PEDIATRICS

Information about “1992970552” NPI (LISA LINN SANTO DOMINGO CRNP-PEDIATRICS) exists in 1992970552 in HTML format HTML  |  1992970552 in plain Text format TXT  |  1992970552 in PDF (Portable Document Format) PDF  |  1992970552 in an XML format XML  formats.

NPI Number : 1992970552 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992970552",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SANTO DOMINGO",
    "FirstName": "LISA",
    "MiddleName": "LINN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "CRNP-PEDIATRICS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SEAMAN",
    "OtherFirstName": "LISA",
    "OtherMiddleName": "LINN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "CRNP-PEDIATRICS",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "600 N WOLFE ST",
    "SecondLineMailingAddress": "BRADY 320",
    "MailingAddressCityName": "BALTIMORE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21287-0005",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "410-955-8769",
    "MailingAddressFaxNumber": "410-955-1464",
    "FirstLinePracticeLocationAddress": "600 N WOLFE ST",
    "SecondLinePracticeLocationAddress": "BRADY 320",
    "PracticeLocationAddressCityName": "BALTIMORE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21287-0005",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "410-955-8769",
    "PracticeLocationAddressFaxNumber": "410-955-1464",
    "EnumerationDate": "04/24/2008",
    "LastUpdateDate": "08/10/2012",
    "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": "363LP0200X",
        "TaxonomyName": "Pediatric Nurse Practitioner",
        "LicenseNumber": "R175012",
        "LicenseNumberStateCode": "MD",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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