{
"Npi": {
"NPI": "1003893108",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "NILAND",
"FirstName": "LORI",
"MiddleName": "A",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DOREN",
"OtherFirstName": "LORI",
"OtherMiddleName": "A",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PAC-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 16023",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LEWISTON",
"MailingAddressStateName": "ME",
"MailingAddressPostalCode": "04243-9503",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "207-396-8600",
"MailingAddressFaxNumber": "603-692-6040",
"FirstLinePracticeLocationAddress": "22 BRAMHALL STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PORTLAND",
"PracticeLocationAddressStateName": "ME",
"PracticeLocationAddressPostalCode": "04102",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "207-662-2934",
"PracticeLocationAddressFaxNumber": "207-662-6389",
"EnumerationDate": "12/29/2005",
"LastUpdateDate": "01/08/2015",
"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": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA-620",
"LicenseNumberStateCode": "ME",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "0859",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA620",
"LicenseNumberStateCode": "ME",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}