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1316425424 NPI number — JEANNE THERESE GUGUDIS NP

NPI Number: 1316425424
Health Care Provider/Practitioner: JEANNE THERESE GUGUDIS NP

Information about “1316425424” NPI (JEANNE THERESE GUGUDIS NP) exists in 1316425424 in HTML format HTML  |  1316425424 in plain Text format TXT  |  1316425424 in PDF (Portable Document Format) PDF  |  1316425424 in an XML format XML  formats.

NPI Number : 1316425424 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1316425424",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GUGUDIS",
    "FirstName": "JEANNE",
    "MiddleName": "THERESE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16705 WALTER ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTHGATE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48195-2984",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "734-281-1543",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2800 W GRAND BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DETROIT",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48202-2610",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "313-799-6619",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/31/2018",
    "LastUpdateDate": "02/15/2021",
    "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": "363L00000X",
        "TaxonomyName": "Nurse Practitioner",
        "LicenseNumber": "4704176174",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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