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1619176385 NPI number — NICOLE JONELLE O'NEILL MD

NPI Number: 1619176385
Health Care Provider/Practitioner: NICOLE JONELLE O'NEILL MD

Information about “1619176385” NPI (NICOLE JONELLE O'NEILL MD) exists in 1619176385 in HTML format HTML  |  1619176385 in plain Text format TXT  |  1619176385 in PDF (Portable Document Format) PDF  |  1619176385 in an XML format XML  formats.

NPI Number : 1619176385 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619176385",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "O'NEILL",
    "FirstName": "NICOLE",
    "MiddleName": "JONELLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "TROMBLE",
    "OtherFirstName": "NICOLE",
    "OtherMiddleName": "JONELLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.D.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2250 OAK ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WYANDOTTE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48192-5318",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "734-780-7070",
    "MailingAddressFaxNumber": "844-633-2487",
    "FirstLinePracticeLocationAddress": "2250 OAK ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WYANDOTTE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48192-5318",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "734-780-7070",
    "PracticeLocationAddressFaxNumber": "844-633-2487",
    "EnumerationDate": "07/13/2007",
    "LastUpdateDate": "04/22/2025",
    "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": "207R00000X",
        "TaxonomyName": "Internal Medicine Physician",
        "LicenseNumber": "4301090868",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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