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1083378830 NPI number — MADISON LYNN RANEW MS, RD, LDN

NPI Number: 1083378830
Health Care Provider/Practitioner: MADISON LYNN RANEW MS, RD, LDN

Information about “1083378830” NPI (MADISON LYNN RANEW MS, RD, LDN) exists in 1083378830 in HTML format HTML  |  1083378830 in plain Text format TXT  |  1083378830 in PDF (Portable Document Format) PDF  |  1083378830 in an XML format XML  formats.

NPI Number : 1083378830 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083378830",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RANEW",
    "FirstName": "MADISON",
    "MiddleName": "LYNN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, RD, LDN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "COBB",
    "OtherFirstName": "MADISON",
    "OtherMiddleName": "LYNN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "170 PERGOLA PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ORMOND BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32174-1061",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "352-201-1947",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "551 NATIONAL HEALTH CARE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAYTONA BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32114-1495",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "386-323-7500",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/27/2021",
    "LastUpdateDate": "10/27/2021",
    "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": "133V00000X",
        "TaxonomyName": "Registered Dietitian",
        "LicenseNumber": "ND9465",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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