{
"Npi": {
"NPI": "1861863607",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CHEVALIER",
"FirstName": "NICOLE",
"MiddleName": "MARIE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "COTTLE",
"OtherFirstName": "NICOLE",
"OtherMiddleName": "MARIE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "243 STEELE RD APT 636",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST HARTFORD",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06117-1724",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "801-726-4560",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "100 RETREAT AVE STE 603",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HARTFORD",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06106-2528",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "860-246-3533",
"PracticeLocationAddressFaxNumber": "960-246-3540",
"EnumerationDate": "10/19/2015",
"LastUpdateDate": "07/07/2025",
"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": "363AS0400X",
"TaxonomyName": "Surgical Physician Assistant",
"LicenseNumber": "3449",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}