NPI Code Detail JSON Logo

1104405216 NPI number — NICOLE ANN DOMINIQUE-BRANLEY MD

NPI Number: 1104405216
Health Care Provider/Practitioner: NICOLE ANN DOMINIQUE-BRANLEY MD

Information about “1104405216” NPI (NICOLE ANN DOMINIQUE-BRANLEY MD) exists in 1104405216 in HTML format HTML  |  1104405216 in plain Text format TXT  |  1104405216 in PDF (Portable Document Format) PDF  |  1104405216 in an XML format XML  formats.

NPI Number : 1104405216 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104405216",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DOMINIQUE-BRANLEY",
    "FirstName": "NICOLE",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DOMINIQUE",
    "OtherFirstName": "NICOLE",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "725 WELCH RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PALO ALTO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94304-1601",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "650-497-8000",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "604 N ACADIA RD STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "THIBODAUX",
    "PracticeLocationAddressStateName": "LA",
    "PracticeLocationAddressPostalCode": "70301-4897",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "985-447-9045",
    "PracticeLocationAddressFaxNumber": "985-447-3349",
    "EnumerationDate": "04/06/2021",
    "LastUpdateDate": "10/04/2024",
    "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": "208000000X",
        "TaxonomyName": "Pediatrics Physician",
        "LicenseNumber": "340450",
        "LicenseNumberStateCode": "LA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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