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1104571207 NPI number — ADOLPHINE DIWA

NPI Number: 1104571207
Health Care Provider/Practitioner: ADOLPHINE DIWA

Information about “1104571207” NPI (ADOLPHINE DIWA) exists in 1104571207 in HTML format HTML  |  1104571207 in plain Text format TXT  |  1104571207 in PDF (Portable Document Format) PDF  |  1104571207 in an XML format XML  formats.

NPI Number : 1104571207 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104571207",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DIWA",
    "FirstName": "ADOLPHINE",
    "MiddleName": null,
    "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": "702 RUSSELL AVE STE 306",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GAITHERSBURG",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "20877-2606",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "301-956-6141",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "702 RUSSELL AVE STE 306",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GAITHERSBURG",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "20877-2606",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "301-956-6141",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/16/2022",
    "LastUpdateDate": "01/24/2026",
    "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": "376K00000X",
          "TaxonomyName": "Nurse's Aide",
          "LicenseNumber": "A00198292",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": "R03788",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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