{
"Npi": {
"NPI": "1174087605",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JACOBSON",
"FirstName": "ANNIE",
"MiddleName": "L",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "RDN, LN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BERTRAND",
"OtherFirstName": "ANNIE",
"OtherMiddleName": "L",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "RDN, LN",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 5074",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SIOUX FALLS",
"MailingAddressStateName": "SD",
"MailingAddressPostalCode": "57117-5074",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "605-328-9419",
"MailingAddressFaxNumber": "605-626-4251",
"FirstLinePracticeLocationAddress": "3015 3RD AVE SE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ABERDEEN",
"PracticeLocationAddressStateName": "SD",
"PracticeLocationAddressPostalCode": "57401-5418",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "605-226-5500",
"PracticeLocationAddressFaxNumber": "605-626-4251",
"EnumerationDate": "01/29/2019",
"LastUpdateDate": "12/06/2024",
"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": "133N00000X",
"TaxonomyName": "Nutritionist",
"LicenseNumber": "0358",
"LicenseNumberStateCode": "SD",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "133V00000X",
"TaxonomyName": "Registered Dietitian",
"LicenseNumber": "1066",
"LicenseNumberStateCode": "ND",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "133V00000X",
"TaxonomyName": "Registered Dietitian",
"LicenseNumber": "998682",
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "133V00000X",
"TaxonomyName": "Registered Dietitian",
"LicenseNumber": "0358",
"LicenseNumberStateCode": "SD",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}