1447440060 NPI number — ELLEN ADELIA DOEBLER PA-C, LRD, CDE

NPI Number: 1447440060
Health Care Provider/Practitioner: ELLEN ADELIA DOEBLER PA-C, LRD, CDE

NPI Number : 1447440060 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1447440060",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DOEBLER",
    "FirstName": "ELLEN",
    "MiddleName": "ADELIA",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PA-C, LRD, CDE",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KAISER",
    "OtherFirstName": "ELLEN",
    "OtherMiddleName": "ADELIA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "P.A",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "220 CAMPUS BLVD STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WINCHESTER",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22601-2888",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "540-536-5100",
    "MailingAddressFaxNumber": "540-536-0235",
    "FirstLinePracticeLocationAddress": "4803 GERRARDSTOWN RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INWOOD",
    "PracticeLocationAddressStateName": "WV",
    "PracticeLocationAddressPostalCode": "25428-3450",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "304-821-9011",
    "PracticeLocationAddressFaxNumber": "304-821-9012",
    "EnumerationDate": "07/30/2007",
    "LastUpdateDate": "03/06/2021",
    "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": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "0110006335",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "2064",
          "LicenseNumberStateCode": "WV",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}