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1174720452 NPI number — LISA MARIE SKOWRON MAMS, BCO, BADO, CCA

NPI Number: 1174720452
Health Care Provider/Practitioner: LISA MARIE SKOWRON MAMS, BCO, BADO, CCA

Information about “1174720452” NPI (LISA MARIE SKOWRON MAMS, BCO, BADO, CCA) exists in 1174720452 in HTML format HTML  |  1174720452 in plain Text format TXT  |  1174720452 in PDF (Portable Document Format) PDF  |  1174720452 in an XML format XML  formats.

NPI Number : 1174720452 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174720452",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SKOWRON",
    "FirstName": "LISA",
    "MiddleName": "MARIE",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": "MAMS, BCO, BADO, CCA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SKOWRON",
    "OtherFirstName": "LISA",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "MAMS, BCO, BADO, CCA",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "23605 N HIGH RIDGE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKE ZURICH",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60047-9048",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-719-2984",
    "MailingAddressFaxNumber": "847-719-2984",
    "FirstLinePracticeLocationAddress": "23605 N HIGH RIDGE DR",
    "SecondLinePracticeLocationAddress": "CHRYSALIS ANAPLASTOLOGY INC",
    "PracticeLocationAddressCityName": "LAKE ZURICH",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60047-9048",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-719-2984",
    "PracticeLocationAddressFaxNumber": "847-719-2984",
    "EnumerationDate": "06/29/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "174400000X",
        "TaxonomyName": "Specialist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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