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1023907086 NPI number — RAQUEL MARY BLASSINGAME

NPI Number: 1023907086
Health Care Provider/Practitioner: RAQUEL MARY BLASSINGAME

Information about “1023907086” NPI (RAQUEL MARY BLASSINGAME) exists in 1023907086 in HTML format HTML  |  1023907086 in plain Text format TXT  |  1023907086 in PDF (Portable Document Format) PDF  |  1023907086 in an XML format XML  formats.

NPI Number : 1023907086 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023907086",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLASSINGAME",
    "FirstName": "RAQUEL",
    "MiddleName": "MARY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "STARCHILD",
    "OtherFirstName": "SOLENE",
    "OtherMiddleName": "LYSARA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "511 N LINCOLN ST STE 31",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HIGH SHOALS",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28077-9700",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-601-2646",
    "MailingAddressFaxNumber": "704-240-3393",
    "FirstLinePracticeLocationAddress": "121 W MAIN AVE STE 302",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GASTONIA",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28052-4154",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-601-2646",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/02/2025",
    "LastUpdateDate": "07/02/2025",
    "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": "174H00000X",
          "TaxonomyName": "Health Educator",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171400000X",
          "TaxonomyName": "Health & Wellness Coach",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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