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1629586680 NPI number — MISS MICHELLE THERESE NIN

NPI Number: 1629586680
Health Care Provider/Practitioner: MISS MICHELLE THERESE NIN

Information about “1629586680” NPI (MISS MICHELLE THERESE NIN) exists in 1629586680 in HTML format HTML  |  1629586680 in plain Text format TXT  |  1629586680 in PDF (Portable Document Format) PDF  |  1629586680 in an XML format XML  formats.

NPI Number : 1629586680 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629586680",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NIN",
    "FirstName": "MICHELLE",
    "MiddleName": "THERESE",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8506 CAMDEN CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BROADVIEW HEIGHTS",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "44147-1782",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4550 W 150TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CLEVELAND",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44135-3460",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "216-838-6750",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/11/2018",
    "LastUpdateDate": "09/14/2018",
    "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": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "COND.2017356-SP",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "13012",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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