NPI Code Detail JSON Logo

1194869818 NPI number — TINA-MARIE THIEBAUT

NPI Number: 1194869818
Health Care Provider/Practitioner: TINA-MARIE THIEBAUT

Information about “1194869818” NPI (TINA-MARIE THIEBAUT) exists in 1194869818 in HTML format HTML  |  1194869818 in plain Text format TXT  |  1194869818 in PDF (Portable Document Format) PDF  |  1194869818 in an XML format XML  formats.

NPI Number : 1194869818 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194869818",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "THIEBAUT",
    "FirstName": "TINA-MARIE",
    "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": "13272 COLUMBINE CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "THORNTON",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80241-2072",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "303-280-2496",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4803 WARD RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WHEAT RIDGE",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80033-1902",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "303-743-5855",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/16/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "207R00000X",
        "TaxonomyName": "Internal Medicine Physician",
        "LicenseNumber": "98117",
        "LicenseNumberStateCode": "CO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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