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1760775647 NPI number — DEBORAH J GILLHAM LMP, CCST

NPI Number: 1760775647
Health Care Provider/Practitioner: DEBORAH J GILLHAM LMP, CCST

Information about “1760775647” NPI (DEBORAH J GILLHAM LMP, CCST) exists in 1760775647 in HTML format HTML  |  1760775647 in plain Text format TXT  |  1760775647 in PDF (Portable Document Format) PDF  |  1760775647 in an XML format XML  formats.

NPI Number : 1760775647 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760775647",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GILLHAM",
    "FirstName": "DEBORAH",
    "MiddleName": "J",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMP,  CCST",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "24111 122ND ST E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BUCKLEY",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98321-9575",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "253-224-8875",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4103 BRIDGEPORT WAY W",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "UNIVERSITY PLACE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98466-4300",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "253-460-1824",
    "PracticeLocationAddressFaxNumber": "253-460-1920",
    "EnumerationDate": "05/25/2011",
    "LastUpdateDate": "05/25/2011",
    "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": "174400000X",
        "TaxonomyName": "Specialist",
        "LicenseNumber": "MA00024203",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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