NPI Code Detail JSON Logo

1104622299 NPI number — INA E REDSTONE LMT

NPI Number: 1104622299
Health Care Provider/Practitioner: INA E REDSTONE LMT

Information about “1104622299” NPI (INA E REDSTONE LMT) exists in 1104622299 in HTML format HTML  |  1104622299 in plain Text format TXT  |  1104622299 in PDF (Portable Document Format) PDF  |  1104622299 in an XML format XML  formats.

NPI Number : 1104622299 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104622299",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "REDSTONE",
    "FirstName": "INA",
    "MiddleName": "E",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BUEHNE",
    "OtherFirstName": "INA",
    "OtherMiddleName": "E",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LMT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5 EXECUTIVE WOODS COURT",
    "SecondLineMailingAddress": "UNITED C - INDIGO SUITE",
    "MailingAddressCityName": "SWANSEA",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62226",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5 EXECUTIVE WOODS COURT",
    "SecondLinePracticeLocationAddress": "UNITED C - INDIGO SUITE",
    "PracticeLocationAddressCityName": "SWANSEA",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62226",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "618-444-8986",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/20/2025",
    "LastUpdateDate": "02/20/2025",
    "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": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": "2024041711",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": "227.023898",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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