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1750597720 NPI number — MRS. KYLENE RENEE SERES

NPI Number: 1750597720
Health Care Provider/Practitioner: MRS. KYLENE RENEE SERES

Information about “1750597720” NPI (MRS. KYLENE RENEE SERES) exists in 1750597720 in HTML format HTML  |  1750597720 in plain Text format TXT  |  1750597720 in PDF (Portable Document Format) PDF  |  1750597720 in an XML format XML  formats.

NPI Number : 1750597720 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750597720",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SERES",
    "FirstName": "KYLENE",
    "MiddleName": "RENEE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "COULTER",
    "OtherFirstName": "KYLENE",
    "OtherMiddleName": "RENEE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3030 LYNN AVE",
    "SecondLineMailingAddress": "APT 25",
    "MailingAddressCityName": "MINNEAPOLIS",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55416-4038",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "612-306-7362",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4801 MINNETONKA BLVD",
    "SecondLinePracticeLocationAddress": "POSITIVE BODY DYNAMICS",
    "PracticeLocationAddressCityName": "MINNEAPOLIS",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55416-4038",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "952-920-9514",
    "PracticeLocationAddressFaxNumber": "952-920-9814",
    "EnumerationDate": "05/15/2007",
    "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": "225700000X",
        "TaxonomyName": "Massage Therapist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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