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1063422319 NPI number — THRESIAMMA IDICHANDY NURSE PRACTITIONER

NPI Number: 1063422319
Health Care Provider/Practitioner: THRESIAMMA IDICHANDY NURSE PRACTITIONER

Information about “1063422319” NPI (THRESIAMMA IDICHANDY NURSE PRACTITIONER) exists in 1063422319 in HTML format HTML  |  1063422319 in plain Text format TXT  |  1063422319 in PDF (Portable Document Format) PDF  |  1063422319 in an XML format XML  formats.

NPI Number : 1063422319 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063422319",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "IDICHANDY",
    "FirstName": "THRESIAMMA",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "NURSE PRACTITIONER",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9618 PEACH TREE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROWLETT",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75089-8508",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-408-8116",
    "MailingAddressFaxNumber": "248-408-8116",
    "FirstLinePracticeLocationAddress": "234 W CAMPBELL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RICHARDSON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75080-3512",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "972-474-3221",
    "PracticeLocationAddressFaxNumber": "512-782-9316",
    "EnumerationDate": "08/09/2006",
    "LastUpdateDate": "10/07/2025",
    "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": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "1207120",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "4704171067",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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