NPI Code Detail JSON Logo

1477943736 NPI number — DONITA MITCHELL-GAGE CERTIFIED HAIR LOSS

NPI Number: 1477943736
Health Care Provider/Practitioner: DONITA MITCHELL-GAGE CERTIFIED HAIR LOSS

Information about “1477943736” NPI (DONITA MITCHELL-GAGE CERTIFIED HAIR LOSS) exists in 1477943736 in HTML format HTML  |  1477943736 in plain Text format TXT  |  1477943736 in PDF (Portable Document Format) PDF  |  1477943736 in an XML format XML  formats.

NPI Number : 1477943736 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477943736",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MITCHELL-GAGE",
    "FirstName": "DONITA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CERTIFIED HAIR LOSS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1369 ROSEMARY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOLINGBROOK",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60490-4940",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "708-516-0128",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "619 E BOUGHTON RD",
    "SecondLinePracticeLocationAddress": "STE 143-II",
    "PracticeLocationAddressCityName": "BOLINGBROOK",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60440-2486",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "708-516-0128",
    "PracticeLocationAddressFaxNumber": "815-782-6900",
    "EnumerationDate": "01/26/2015",
    "LastUpdateDate": "04/08/2015",
    "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": "1744P3200X",
        "TaxonomyName": "Prosthetics Case Management",
        "LicenseNumber": "012.008279",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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