1497986855 NPI number — MAXINE ELIZABETH FIDLER N.D., L.AC.

NPI Number: 1497986855
Health Care Provider/Practitioner: MAXINE ELIZABETH FIDLER N.D., L.AC.

NPI Number : 1497986855 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497986855",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FIDLER",
    "FirstName": "MAXINE",
    "MiddleName": "ELIZABETH",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "N.D., L.AC.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HUDA",
    "OtherFirstName": "MAXINE",
    "OtherMiddleName": "ELIZABETH",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "39 OTTERSIDE COURT NORTH",
    "SecondLineMailingAddress": "#24",
    "MailingAddressCityName": "MIDDLEBURY",
    "MailingAddressStateName": "VT",
    "MailingAddressPostalCode": "05753",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "802-349-0440",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "31 COURT STREET",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MIDDLEBURY",
    "PracticeLocationAddressStateName": "VT",
    "PracticeLocationAddressPostalCode": "05753",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "802-349-0440",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/04/2009",
    "LastUpdateDate": "08/05/2009",
    "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": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "VT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175F00000X",
          "TaxonomyName": "Naturopath",
          "LicenseNumber": "099-0000256",
          "LicenseNumberStateCode": "VT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}