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1679147441 NPI number — JENNIFER ROSE LEAVER

NPI Number: 1679147441
Health Care Provider/Practitioner: JENNIFER ROSE LEAVER

Information about “1679147441” NPI (JENNIFER ROSE LEAVER) exists in 1679147441 in HTML format HTML  |  1679147441 in plain Text format TXT  |  1679147441 in PDF (Portable Document Format) PDF  |  1679147441 in an XML format XML  formats.

NPI Number : 1679147441 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679147441",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEAVER",
    "FirstName": "JENNIFER",
    "MiddleName": "ROSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PERREY",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "ROSE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2831 ZION LN APT 201",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CASPER",
    "MailingAddressStateName": "WY",
    "MailingAddressPostalCode": "82609-5136",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "307-315-2006",
    "MailingAddressFaxNumber": "307-337-1320",
    "FirstLinePracticeLocationAddress": "2241 FARNUM ST STE 102",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CASPER",
    "PracticeLocationAddressStateName": "WY",
    "PracticeLocationAddressPostalCode": "82609-4108",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "307-337-1304",
    "PracticeLocationAddressFaxNumber": "307-337-1320",
    "EnumerationDate": "05/17/2021",
    "LastUpdateDate": "05/17/2021",
    "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": "251B00000X",
        "TaxonomyName": "Case Management Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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