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1528671328 NPI number — CHARITY M LICKFOLD MFP, CPT, CNC

NPI Number: 1528671328
Health Care Provider/Practitioner: CHARITY M LICKFOLD MFP, CPT, CNC

Information about “1528671328” NPI (CHARITY M LICKFOLD MFP, CPT, CNC) exists in 1528671328 in HTML format HTML  |  1528671328 in plain Text format TXT  |  1528671328 in PDF (Portable Document Format) PDF  |  1528671328 in an XML format XML  formats.

NPI Number : 1528671328 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528671328",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LICKFOLD",
    "FirstName": "CHARITY",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MFP, CPT, CNC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 555",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CLATSKANIE",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97016-0555",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-704-7632",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "580 NE POPLAR ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CLATSKANIE",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97016-7470",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-704-7632",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/31/2020",
    "LastUpdateDate": "05/21/2024",
    "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": "133N00000X",
          "TaxonomyName": "Nutritionist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171400000X",
          "TaxonomyName": "Health & Wellness Coach",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "224Y00000X",
          "TaxonomyName": "Clinical Exercise Physiologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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