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1932500873 NPI number — JACKIE C BORUP LMP

NPI Number: 1932500873
Health Care Provider/Practitioner: JACKIE C BORUP LMP

Information about “1932500873” NPI (JACKIE C BORUP LMP) exists in 1932500873 in HTML format HTML  |  1932500873 in plain Text format TXT  |  1932500873 in PDF (Portable Document Format) PDF  |  1932500873 in an XML format XML  formats.

NPI Number : 1932500873 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1932500873",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BORUP",
    "FirstName": "JACKIE",
    "MiddleName": "C",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "117 E INGLEWOOD DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MOSES LAKE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98837-2561",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "509-431-5824",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "226 W 3RD AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MOSES LAKE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98837-1933",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "509-765-4174",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/10/2014",
    "LastUpdateDate": "09/10/2014",
    "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": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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