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1417282682 NPI number — LOIS AMY TOBIN RD,CSR,LD

NPI Number: 1417282682
Health Care Provider/Practitioner: LOIS AMY TOBIN RD,CSR,LD

Information about “1417282682” NPI (LOIS AMY TOBIN RD,CSR,LD) exists in 1417282682 in HTML format HTML  |  1417282682 in plain Text format TXT  |  1417282682 in PDF (Portable Document Format) PDF  |  1417282682 in an XML format XML  formats.

NPI Number : 1417282682 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417282682",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TOBIN",
    "FirstName": "LOIS",
    "MiddleName": "AMY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RD,CSR,LD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "13520 SW AERIE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TIGARD",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97223-2807",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-524-4541",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6902 SE LAKE RD",
    "SecondLinePracticeLocationAddress": "SUITE 302",
    "PracticeLocationAddressCityName": "MILWAUKIE",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97267-2148",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-786-1148",
    "PracticeLocationAddressFaxNumber": "503-786-1170",
    "EnumerationDate": "10/06/2009",
    "LastUpdateDate": "10/06/2009",
    "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": "133VN1005X",
        "TaxonomyName": "Renal Nutrition Registered Dietitian",
        "LicenseNumber": "225",
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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