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1700194529 NPI number — KIM ROBERTA NUESSE CDP, BA

NPI Number: 1700194529
Health Care Provider/Practitioner: KIM ROBERTA NUESSE CDP, BA

Information about “1700194529” NPI (KIM ROBERTA NUESSE CDP, BA) exists in 1700194529 in HTML format HTML  |  1700194529 in plain Text format TXT  |  1700194529 in PDF (Portable Document Format) PDF  |  1700194529 in an XML format XML  formats.

NPI Number : 1700194529 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700194529",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NUESSE",
    "FirstName": "KIM",
    "MiddleName": "ROBERTA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CDP, BA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 1847",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LONGVIEW",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98632-8140",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-423-0203",
    "MailingAddressFaxNumber": "360-577-0187",
    "FirstLinePracticeLocationAddress": "720 14TH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LONGVIEW",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98632-2315",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-423-0203",
    "PracticeLocationAddressFaxNumber": "360-577-0187",
    "EnumerationDate": "09/14/2010",
    "LastUpdateDate": "01/23/2023",
    "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": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "CP00003613",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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