1194132985 NPI number — MELISSA ANNE KOCHUBA R.N, I.B.C.L.C

NPI Number: 1194132985
Health Care Provider/Practitioner: MELISSA ANNE KOCHUBA R.N, I.B.C.L.C

NPI Number : 1194132985 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194132985",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KOCHUBA",
    "FirstName": "MELISSA",
    "MiddleName": "ANNE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "R.N, I.B.C.L.C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "12608 LAKE NORMANDY LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FAIRFAX",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22030-7251",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "516-993-3094",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12608 LAKE NORMANDY LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAIRFAX",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22030-7251",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "516-993-3094",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/14/2014",
    "LastUpdateDate": "12/17/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163WL0100X",
          "TaxonomyName": "Lactation Consultant (Registered Nurse)",
          "LicenseNumber": "6171021",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WL0100X",
          "TaxonomyName": "Lactation Consultant (Registered Nurse)",
          "LicenseNumber": "617102-1",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}