NPI Code Detail JSON Logo

1649088733 NPI number — BRE MICHELLE VANDER WOUDE

NPI Number: 1649088733
Health Care Provider/Practitioner: BRE MICHELLE VANDER WOUDE

Information about “1649088733” NPI (BRE MICHELLE VANDER WOUDE) exists in 1649088733 in HTML format HTML  |  1649088733 in plain Text format TXT  |  1649088733 in PDF (Portable Document Format) PDF  |  1649088733 in an XML format XML  formats.

NPI Number : 1649088733 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649088733",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VANDER WOUDE",
    "FirstName": "BRE",
    "MiddleName": "MICHELLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SHAW",
    "OtherFirstName": "BRITTANI",
    "OtherMiddleName": "MICHELLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3700 ETHEL AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WACO",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76707-1632",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "254-715-1187",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "15140 BADGER RANCH BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WOODWAY",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76712-8983",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "254-545-2674",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/21/2024",
    "LastUpdateDate": "12/21/2024",
    "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": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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