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1699563023 NPI number — REBEKAH ATWATER CLC, PCD

NPI Number: 1699563023
Health Care Provider/Practitioner: REBEKAH ATWATER CLC, PCD

Information about “1699563023” NPI (REBEKAH ATWATER CLC, PCD) exists in 1699563023 in HTML format HTML  |  1699563023 in plain Text format TXT  |  1699563023 in PDF (Portable Document Format) PDF  |  1699563023 in an XML format XML  formats.

NPI Number : 1699563023 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1699563023",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ATWATER",
    "FirstName": "REBEKAH",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CLC, PCD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "43221 VALIANT DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHANTILLY",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "20152-3425",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "703-662-1769",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8245 BOONE BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TYSONS",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22182-3828",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "703-662-1769",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/26/2025",
    "LastUpdateDate": "04/26/2025",
    "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": "174N00000X",
          "TaxonomyName": "Lactation Consultant (Non-RN)",
          "LicenseNumber": "284018",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "374J00000X",
          "TaxonomyName": "Doula",
          "LicenseNumber": "14811",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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