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1184096729 NPI number — SANDRA LEE BLAKE RD, LD

NPI Number: 1184096729
Health Care Provider/Practitioner: SANDRA LEE BLAKE RD, LD

Information about “1184096729” NPI (SANDRA LEE BLAKE RD, LD) exists in 1184096729 in HTML format HTML  |  1184096729 in plain Text format TXT  |  1184096729 in PDF (Portable Document Format) PDF  |  1184096729 in an XML format XML  formats.

NPI Number : 1184096729 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1184096729",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLAKE",
    "FirstName": "SANDRA",
    "MiddleName": "LEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RD, LD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FAIT",
    "OtherFirstName": "SANDRA",
    "OtherMiddleName": "LEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "45 10TH ST W",
    "SecondLineMailingAddress": "NUTRITION SERVICES G447",
    "MailingAddressCityName": "SAINT PAUL",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55102-1062",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "651-232-3463",
    "MailingAddressFaxNumber": "651-326-8783",
    "FirstLinePracticeLocationAddress": "45 10TH ST W",
    "SecondLinePracticeLocationAddress": "NUTRITION SERVICES G447",
    "PracticeLocationAddressCityName": "SAINT PAUL",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55102-1062",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-232-3463",
    "PracticeLocationAddressFaxNumber": "651-326-8783",
    "EnumerationDate": "10/22/2015",
    "LastUpdateDate": "10/22/2015",
    "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": "1424",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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