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1609609643 NPI number — COURTNEY GAYL COLEMAN THW

NPI Number: 1609609643
Health Care Provider/Practitioner: COURTNEY GAYL COLEMAN THW

Information about “1609609643” NPI (COURTNEY GAYL COLEMAN THW) exists in 1609609643 in HTML format HTML  |  1609609643 in plain Text format TXT  |  1609609643 in PDF (Portable Document Format) PDF  |  1609609643 in an XML format XML  formats.

NPI Number : 1609609643 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609609643",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COLEMAN",
    "FirstName": "COURTNEY",
    "MiddleName": "GAYL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "THW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "60575 BILLADEAU RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BEND",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97702-9338",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "541-389-1848",
    "MailingAddressFaxNumber": "541-550-7956",
    "FirstLinePracticeLocationAddress": "60575 BILLADEAU RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BEND",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97702-9338",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "541-389-1848",
    "PracticeLocationAddressFaxNumber": "541-550-7956",
    "EnumerationDate": "08/23/2024",
    "LastUpdateDate": "08/23/2024",
    "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": "172V00000X",
        "TaxonomyName": "Community Health Worker",
        "LicenseNumber": "112035",
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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