NPI Code Detail JSON Logo

1902860141 NPI number — JENNA LYNN DECRAENE A.T.C., LAT

NPI Number: 1902860141
Health Care Provider/Practitioner: JENNA LYNN DECRAENE A.T.C., LAT

Information about “1902860141” NPI (JENNA LYNN DECRAENE A.T.C., LAT) exists in 1902860141 in HTML format HTML  |  1902860141 in plain Text format TXT  |  1902860141 in PDF (Portable Document Format) PDF  |  1902860141 in an XML format XML  formats.

NPI Number : 1902860141 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902860141",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DECRAENE",
    "FirstName": "JENNA",
    "MiddleName": "LYNN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "A.T.C., LAT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "952 SKILLET AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HUNTERTOWN",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46748-0109",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "260-515-0065",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7920 W JEFFERSON BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 100",
    "PracticeLocationAddressCityName": "FORT WAYNE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46804-4168",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "260-459-0917",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/14/2006",
    "LastUpdateDate": "08/27/2022",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "36001248A",
        "LicenseNumberStateCode": "IN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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