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1508643750 NPI number — JENNIFER LEE BLAKE NP

NPI Number: 1508643750
Health Care Provider/Practitioner: JENNIFER LEE BLAKE NP

Information about “1508643750” NPI (JENNIFER LEE BLAKE NP) exists in 1508643750 in HTML format HTML  |  1508643750 in plain Text format TXT  |  1508643750 in PDF (Portable Document Format) PDF  |  1508643750 in an XML format XML  formats.

NPI Number : 1508643750 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1508643750",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLAKE",
    "FirstName": "JENNIFER",
    "MiddleName": "LEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WALLINGTON",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "LEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "159 ANNA FARM RD E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NORTH STONINGTON",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06359-1035",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "401-741-9862",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "71 HAYNES ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MANCHESTER",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06040-4188",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "860-646-1222",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/12/2023",
    "LastUpdateDate": "09/15/2023",
    "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": "363LA2100X",
        "TaxonomyName": "Acute Care Nurse Practitioner",
        "LicenseNumber": "12319",
        "LicenseNumberStateCode": "CT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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