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1770491292 NPI number — MELYSE BLANDINE ISHIMWE

NPI Number: 1770491292
Health Care Provider/Practitioner: MELYSE BLANDINE ISHIMWE

Information about “1770491292” NPI (MELYSE BLANDINE ISHIMWE) exists in 1770491292 in HTML format HTML  |  1770491292 in plain Text format TXT  |  1770491292 in PDF (Portable Document Format) PDF  |  1770491292 in an XML format XML  formats.

NPI Number : 1770491292 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770491292",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ISHIMWE",
    "FirstName": "MELYSE",
    "MiddleName": "BLANDINE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1005 N HICKORY RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTH BEND",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46615-3723",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "574-233-5754",
    "MailingAddressFaxNumber": "574-233-7406",
    "FirstLinePracticeLocationAddress": "1005 N HICKORY RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTH BEND",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46615-3723",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "574-233-5754",
    "PracticeLocationAddressFaxNumber": "574-233-7406",
    "EnumerationDate": "08/28/2026",
    "LastUpdateDate": "08/28/2026",
    "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": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "99138470A",
        "LicenseNumberStateCode": "IN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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