{
"Npi": {
"NPI": "1003026840",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WELLS",
"FirstName": "LINDA",
"MiddleName": "SUE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "LVN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "NUTALL",
"OtherFirstName": "LINDA",
"OtherMiddleName": "SUE",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "LVN",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "1808 RANCHO ENCANTADO COURT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MODESTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95358",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-596-7477",
"MailingAddressFaxNumber": "800-611-7121",
"FirstLinePracticeLocationAddress": "1808 RANCHO ENCANTADO COURT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MODESTO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95358-7128",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-596-7477",
"PracticeLocationAddressFaxNumber": "800-611-7128",
"EnumerationDate": "05/23/2007",
"LastUpdateDate": "09/03/2021",
"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": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "VN149689",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}