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1033638952 NPI number — AMY HANNEKE RDN, LD

NPI Number: 1033638952
Health Care Provider/Practitioner: AMY HANNEKE RDN, LD

Information about “1033638952” NPI (AMY HANNEKE RDN, LD) exists in 1033638952 in HTML format HTML  |  1033638952 in plain Text format TXT  |  1033638952 in PDF (Portable Document Format) PDF  |  1033638952 in an XML format XML  formats.

NPI Number : 1033638952 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033638952",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HANNEKE",
    "FirstName": "AMY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RDN, LD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LEE",
    "OtherFirstName": "AMY",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "RDN, LD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "164 S. 5TH ST.",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MONTPELIER",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83254",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-847-1630",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "320 ASHLAND ST.",
    "SecondLinePracticeLocationAddress": "APT. 1",
    "PracticeLocationAddressCityName": "SODA SPRINGS",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83276-8327",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-591-6429",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/12/2017",
    "LastUpdateDate": "03/20/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "03/07/2018",
    "NPIReactivationDate": "03/20/2018",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "133V00000X",
        "TaxonomyName": "Registered Dietitian",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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