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1255442802 NPI number — MELODYE LEE PACHECO

NPI Number: 1255442802
Health Care Provider/Practitioner: MELODYE LEE PACHECO

Information about “1255442802” NPI (MELODYE LEE PACHECO) exists in 1255442802 in HTML format HTML  |  1255442802 in plain Text format TXT  |  1255442802 in PDF (Portable Document Format) PDF  |  1255442802 in an XML format XML  formats.

NPI Number : 1255442802 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255442802",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PACHECO",
    "FirstName": "MELODYE",
    "MiddleName": "LEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SHANE",
    "OtherFirstName": "MELODYE",
    "OtherMiddleName": "LEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1221 NE 267TH AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CAMAS",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98607-8905",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-834-3171",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12607 SE MILL PLAIN BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VANCOUVER",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98684-6055",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-896-4456",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/31/2006",
    "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": "156FX1800X",
        "TaxonomyName": "Optician",
        "LicenseNumber": "DO00001784",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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