NPI Code Detail JSON Logo

1275817835 NPI number — REBECCA JUNE CLARK LMP

NPI Number: 1275817835
Health Care Provider/Practitioner: REBECCA JUNE CLARK LMP

Information about “1275817835” NPI (REBECCA JUNE CLARK LMP) exists in 1275817835 in HTML format HTML  |  1275817835 in plain Text format TXT  |  1275817835 in PDF (Portable Document Format) PDF  |  1275817835 in an XML format XML  formats.

NPI Number : 1275817835 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275817835",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CLARK",
    "FirstName": "REBECCA",
    "MiddleName": "JUNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5214 S CREE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPOKANE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "99206-8325",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "509-847-4849",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "325 S SULLIVAN RD",
    "SecondLinePracticeLocationAddress": "SUITE B",
    "PracticeLocationAddressCityName": "SPOKANE VALLEY",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "99037-6019",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "509-928-9098",
    "PracticeLocationAddressFaxNumber": "509-928-9091",
    "EnumerationDate": "09/30/2011",
    "LastUpdateDate": "09/30/2011",
    "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": "MA60205618",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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