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1275152712 NPI number — KATHRYN MUNDALL HOLM RDN, CD, CLC

NPI Number: 1275152712
Health Care Provider/Practitioner: KATHRYN MUNDALL HOLM RDN, CD, CLC

Information about “1275152712” NPI (KATHRYN MUNDALL HOLM RDN, CD, CLC) exists in 1275152712 in HTML format HTML  |  1275152712 in plain Text format TXT  |  1275152712 in PDF (Portable Document Format) PDF  |  1275152712 in an XML format XML  formats.

NPI Number : 1275152712 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275152712",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HOLM",
    "FirstName": "KATHRYN",
    "MiddleName": "MUNDALL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RDN, CD, CLC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MUNDALL",
    "OtherFirstName": "ELONNA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "28806 S 887 PR SE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KENNEWICK",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "99338-1198",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "509-205-1018",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "28806 S 887 PR SE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KENNEWICK",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "99338-1198",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "509-205-1018",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/14/2020",
    "LastUpdateDate": "04/14/2020",
    "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": "174N00000X",
          "TaxonomyName": "Lactation Consultant (Non-RN)",
          "LicenseNumber": "17067",
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133V00000X",
          "TaxonomyName": "Registered Dietitian",
          "LicenseNumber": "917940",
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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