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1053479733 NPI number — LYNNE K REVENO RN CNS

NPI Number: 1053479733
Health Care Provider/Practitioner: LYNNE K REVENO RN CNS

Information about “1053479733” NPI (LYNNE K REVENO RN CNS) exists in 1053479733 in HTML format HTML  |  1053479733 in plain Text format TXT  |  1053479733 in PDF (Portable Document Format) PDF  |  1053479733 in an XML format XML  formats.

NPI Number : 1053479733 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053479733",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "REVENO",
    "FirstName": "LYNNE",
    "MiddleName": "K",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "RN CNS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8 MEADOWVIEW RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MELROSE",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02176-2913",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "617-957-7944",
    "MailingAddressFaxNumber": "781-665-7543",
    "FirstLinePracticeLocationAddress": "1 W FOSTER ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MELROSE",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "02176-3810",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "617-957-7944",
    "PracticeLocationAddressFaxNumber": "781-665-7543",
    "EnumerationDate": "12/05/2006",
    "LastUpdateDate": "08/10/2007",
    "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": "163WP0809X",
        "TaxonomyName": "Adult Psychiatric/Mental Health Registered Nurse",
        "LicenseNumber": "101852",
        "LicenseNumberStateCode": "MA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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