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1225167125 NPI number — LISA NEBEL DPT

NPI Number: 1225167125
Health Care Provider/Practitioner: LISA NEBEL DPT

Information about “1225167125” NPI (LISA NEBEL DPT) exists in 1225167125 in HTML format HTML  |  1225167125 in plain Text format TXT  |  1225167125 in PDF (Portable Document Format) PDF  |  1225167125 in an XML format XML  formats.

NPI Number : 1225167125 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1225167125",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NEBEL",
    "FirstName": "LISA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "OGOREK",
    "OtherFirstName": "LISA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3301 BLUEBERRY LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "APPLETON",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54915-7223",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "920-831-0120",
    "MailingAddressFaxNumber": "920-759-1937",
    "FirstLinePracticeLocationAddress": "316 E 14TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KAUKAUNA",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54130-3304",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "920-766-6020",
    "PracticeLocationAddressFaxNumber": "920-759-1937",
    "EnumerationDate": "03/05/2007",
    "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": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "5968-024",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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