NPI Code Detail JSON Logo

1477941011 NPI number — JOHN BOURQUE L.B.S.W.

NPI Number: 1477941011
Health Care Provider/Practitioner: JOHN BOURQUE L.B.S.W.

Information about “1477941011” NPI (JOHN BOURQUE L.B.S.W.) exists in 1477941011 in HTML format HTML  |  1477941011 in plain Text format TXT  |  1477941011 in PDF (Portable Document Format) PDF  |  1477941011 in an XML format XML  formats.

NPI Number : 1477941011 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477941011",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOURQUE",
    "FirstName": "JOHN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "L.B.S.W.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BOURQUE",
    "OtherFirstName": "DAVID",
    "OtherMiddleName": "JOHN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "L.B.S.W.",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "34807 PHYLLIS ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WAYNE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48184-2422",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "734-722-1000",
    "MailingAddressFaxNumber": "734-722-0368",
    "FirstLinePracticeLocationAddress": "35000 VAN BORN RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WAYNE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48184-2458",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "734-722-1000",
    "PracticeLocationAddressFaxNumber": "734-722-0368",
    "EnumerationDate": "01/06/2015",
    "LastUpdateDate": "01/06/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "104100000X",
        "TaxonomyName": "Social Worker",
        "LicenseNumber": "6802060309",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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