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1063076461 NPI number — NICOLE LOUISE ROBITAILLE

NPI Number: 1063076461
Health Care Provider/Practitioner: NICOLE LOUISE ROBITAILLE

Information about “1063076461” NPI (NICOLE LOUISE ROBITAILLE) exists in 1063076461 in HTML format HTML  |  1063076461 in plain Text format TXT  |  1063076461 in PDF (Portable Document Format) PDF  |  1063076461 in an XML format XML  formats.

NPI Number : 1063076461 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063076461",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROBITAILLE",
    "FirstName": "NICOLE",
    "MiddleName": "LOUISE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "326 WASHINGTON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NORWICH",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06360-2740",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "860-889-8331",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "326 WASHINGTON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORWICH",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06360-2740",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "860-326-8661",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/01/2019",
    "LastUpdateDate": "03/11/2025",
    "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": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "PA2084",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "6924",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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