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1841717188 NPI number — MICHELLE ECKLUND

NPI Number: 1841717188
Health Care Provider/Practitioner: MICHELLE ECKLUND

Information about “1841717188” NPI (MICHELLE ECKLUND) exists in 1841717188 in HTML format HTML  |  1841717188 in plain Text format TXT  |  1841717188 in PDF (Portable Document Format) PDF  |  1841717188 in an XML format XML  formats.

NPI Number : 1841717188 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1841717188",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ECKLUND",
    "FirstName": "MICHELLE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WANTA",
    "OtherFirstName": "MICHELLE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5707 HIGHWAY 7 APT 307",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ST LOUIS PARK",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55416-5084",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "715-741-1214",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1661 SAINT ANTHONY AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT PAUL",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55104-3733",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-968-5201",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/28/2017",
    "LastUpdateDate": "10/30/2017",
    "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": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "10708",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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