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1679161640 NPI number — ISABEL NAOMI DETWILER

NPI Number: 1679161640
Health Care Provider/Practitioner: ISABEL NAOMI DETWILER

Information about “1679161640” NPI (ISABEL NAOMI DETWILER) exists in 1679161640 in HTML format HTML  |  1679161640 in plain Text format TXT  |  1679161640 in PDF (Portable Document Format) PDF  |  1679161640 in an XML format XML  formats.

NPI Number : 1679161640 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679161640",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DETWILER",
    "FirstName": "ISABEL",
    "MiddleName": "NAOMI",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "THORNE",
    "OtherFirstName": "ISABEL",
    "OtherMiddleName": "NAOMI",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "58058 MARLENE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "THREE RIVERS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49093-9346",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "269-262-2400",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "677 E MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CENTREVILLE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49032-8524",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "269-467-1000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/06/2021",
    "LastUpdateDate": "01/09/2023",
    "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": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "6802090857",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "6852090857",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "6851115926",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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