{
"Npi": {
"NPI": "1063287837",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "THIONGO",
"FirstName": "CAROLINE",
"MiddleName": "KEZIAH",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "21155 E DUNCAN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "QUEEN CREEK",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85142-6763",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-302-1431",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "12360 SE SUNNYSIDE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLACKAMAS",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97015-9320",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-303-4000",
"PracticeLocationAddressFaxNumber": "503-344-4412",
"EnumerationDate": "11/21/2023",
"LastUpdateDate": "08/19/2024",
"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": "163WP0808X",
"TaxonomyName": "Psychiatric/Mental Health Registered Nurse",
"LicenseNumber": "298740",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "10021621",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}