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1891418364 NPI number — NICOLE ANNE WALETZKI

NPI Number: 1891418364
Health Care Provider/Practitioner: NICOLE ANNE WALETZKI

Information about “1891418364” NPI (NICOLE ANNE WALETZKI) exists in 1891418364 in HTML format HTML  |  1891418364 in plain Text format TXT  |  1891418364 in PDF (Portable Document Format) PDF  |  1891418364 in an XML format XML  formats.

NPI Number : 1891418364 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1891418364",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALETZKI",
    "FirstName": "NICOLE",
    "MiddleName": "ANNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2991 STUNNING DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LITTLE ELM",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75068-4004",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "571-225-1809",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2900 S VALLEY PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LEWISVILLE",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75067-2077",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "972-829-2111",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/20/2022",
    "LastUpdateDate": "09/20/2022",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "AT8152",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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