{
"Npi": {
"NPI": "1144096769",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MOORE",
"FirstName": "NINA",
"MiddleName": "RAE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PMHNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 3034",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHERRY HILL",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08034-0274",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "646-406-7042",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "222 PHILADELPHIA PIKE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WILMINGTON",
"PracticeLocationAddressStateName": "DE",
"PracticeLocationAddressPostalCode": "19809-3166",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "646-406-7042",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/27/2023",
"LastUpdateDate": "12/04/2023",
"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": "26NR16371200",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "L8-0010539",
"LicenseNumberStateCode": "DE",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}