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1164187514 NPI number — JENNIFER ELAINE LEWIS LMT

NPI Number: 1164187514
Health Care Provider/Practitioner: JENNIFER ELAINE LEWIS LMT

Information about “1164187514” NPI (JENNIFER ELAINE LEWIS LMT) exists in 1164187514 in HTML format HTML  |  1164187514 in plain Text format TXT  |  1164187514 in PDF (Portable Document Format) PDF  |  1164187514 in an XML format XML  formats.

NPI Number : 1164187514 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164187514",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEWIS",
    "FirstName": "JENNIFER",
    "MiddleName": "ELAINE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PERKINS",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "ELAINE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1230 SAINT PAUL AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT PAUL",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55116-2707",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "651-528-2992",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "762 CLEVELAND AVE S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT PAUL",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55116-1347",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-698-4567",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/01/2021",
    "LastUpdateDate": "11/01/2021",
    "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": "225700000X",
        "TaxonomyName": "Massage Therapist",
        "LicenseNumber": "20200002702",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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