{
"Npi": {
"NPI": "1174258412",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SACRED DIVINE FEMININITY, LLC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3612 BRANDES ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ERIE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "16504-3002",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "814-460-3205",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4906 RICHMOND ST STE 6",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ERIE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "16509-1978",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "814-299-9550",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/20/2022",
"LastUpdateDate": "07/20/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PULLIAM-BROWN",
"AuthorizedOfficialFirstName": "SHAWNTA'",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BCNWP,CNHP,CD(DONA)",
"AuthorizedOfficialTelephoneNumber": "814-460-3205",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QB0400X",
"TaxonomyName": "Birthing Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "374J00000X",
"TaxonomyName": "Doula",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}