{
"Npi": {
"NPI": "1134842115",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BRETHAUER",
"FirstName": "HANNAH",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GALLMEIER",
"OtherFirstName": "HANNAH",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2550 UNIVERSITY AVE W STE 110N",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT PAUL",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55114-2001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "651-602-5309",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "675 E NICOLLET BLVD STE 135",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BURNSVILLE",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55337-6770",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "651-312-1700",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/23/2022",
"LastUpdateDate": "09/23/2025",
"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": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "14225",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}