{
"Npi": {
"NPI": "1164554713",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LEO NYHOLM",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "20825 SOUTH ST",
"SecondLineMailingAddress": "SUITE D",
"MailingAddressCityName": "TEHACHAPI",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93561-8649",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "661-822-1965",
"MailingAddressFaxNumber": "661-823-1971",
"FirstLinePracticeLocationAddress": "20825 SOUTH ST",
"SecondLinePracticeLocationAddress": "SUITE D",
"PracticeLocationAddressCityName": "TEHACHAPI",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93561-8649",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "661-822-1965",
"PracticeLocationAddressFaxNumber": "661-823-1971",
"EnumerationDate": "03/09/2007",
"LastUpdateDate": "06/18/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NYHOLM",
"AuthorizedOfficialFirstName": "LEO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BIOANALYST",
"AuthorizedOfficialTelephoneNumber": "661-822-1965",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": "CLF 11592",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}