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1699064055 NPI number — NICOLE ANDREA MANDALA MD

NPI Number: 1699064055
Health Care Provider/Practitioner: NICOLE ANDREA MANDALA MD

Information about “1699064055” NPI (NICOLE ANDREA MANDALA MD) exists in 1699064055 in HTML format HTML  |  1699064055 in plain Text format TXT  |  1699064055 in PDF (Portable Document Format) PDF  |  1699064055 in an XML format XML  formats.

NPI Number : 1699064055 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1699064055",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MANDALA",
    "FirstName": "NICOLE",
    "MiddleName": "ANDREA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "STORNELLI",
    "OtherFirstName": "NICOLE",
    "OtherMiddleName": "ANDREA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "3141 E COPPER RIDGE LOOP",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BILLINGS",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59106-2251",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "303-669-7845",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "801 N 29TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BILLINGS",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59101-0905",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-238-2500",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/06/2011",
    "LastUpdateDate": "02/19/2024",
    "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": "207V00000X",
          "TaxonomyName": "Obstetrics & Gynecology Physician",
          "LicenseNumber": "56276",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207V00000X",
          "TaxonomyName": "Obstetrics & Gynecology Physician",
          "LicenseNumber": "41463",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207V00000X",
          "TaxonomyName": "Obstetrics & Gynecology Physician",
          "LicenseNumber": "MED-PHYS-LIC-41463",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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