{
"Npi": {
"NPI": "1164723656",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PRULLAGE",
"FirstName": "GERALYN",
"MiddleName": "SUE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "APN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PRULLAGE",
"OtherFirstName": "GERALYN",
"OtherMiddleName": "SUE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "APN",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "201 E MADISON ST STE 328",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPRINGFIELD",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62702-5131",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "217-545-8000",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "415 N 9TH ST STE 4W16",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPRINGFIELD",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62702-5303",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "217-545-8000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/15/2010",
"LastUpdateDate": "12/28/2021",
"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": "363LN0005X",
"TaxonomyName": "Critical Care Neonatal Nurse Practitioner",
"LicenseNumber": "041207587",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LN0000X",
"TaxonomyName": "Neonatal Nurse Practitioner",
"LicenseNumber": "209008472",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}