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1003867037 NPI number — JENNIE WALKER ECKSTROM M.D.

NPI Number: 1003867037
Health Care Provider/Practitioner: JENNIE WALKER ECKSTROM M.D.

Information about “1003867037” NPI (JENNIE WALKER ECKSTROM M.D.) exists in 1003867037 in HTML format HTML  |  1003867037 in plain Text format TXT  |  1003867037 in PDF (Portable Document Format) PDF  |  1003867037 in an XML format XML  formats.

NPI Number : 1003867037 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003867037",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ECKSTROM",
    "FirstName": "JENNIE",
    "MiddleName": "WALKER",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WALKER",
    "OtherFirstName": "JENNIE",
    "OtherMiddleName": "KAY",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1111 BAKER AVE",
    "SecondLineMailingAddress": "GLACIER MEDICAL ASSOCIATES",
    "MailingAddressCityName": "WHITEFISH",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59937-2901",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-862-2515",
    "MailingAddressFaxNumber": "406-862-4229",
    "FirstLinePracticeLocationAddress": "1111 BAKER AVE",
    "SecondLinePracticeLocationAddress": "GLACIER MEDICAL ASSOCIATES",
    "PracticeLocationAddressCityName": "WHITEFISH",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59937-2901",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-862-2515",
    "PracticeLocationAddressFaxNumber": "406-862-4229",
    "EnumerationDate": "05/15/2006",
    "LastUpdateDate": "05/12/2008",
    "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": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "M9143",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "10784",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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