{
"Npi": {
"NPI": "1063933653",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MIGNANO",
"FirstName": "STEPHANIE",
"MiddleName": "R",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DPM",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "FLORENCE",
"OtherFirstName": "STEPHANIE",
"OtherMiddleName": "R",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "611 W PARK",
"SecondLineMailingAddress": "FAPC",
"MailingAddressCityName": "URBANA",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61802",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "217-902-6954",
"MailingAddressFaxNumber": "217-902-7711",
"FirstLinePracticeLocationAddress": "611 W PARK",
"SecondLinePracticeLocationAddress": "FAPC",
"PracticeLocationAddressCityName": "URBANA",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "61802",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "217-902-6954",
"PracticeLocationAddressFaxNumber": "217-902-7711",
"EnumerationDate": "07/05/2017",
"LastUpdateDate": "01/16/2025",
"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": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "SC006817",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "213E00000X",
"TaxonomyName": "Podiatrist",
"LicenseNumber": "016006090",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "016006090",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}