{
"Npi": {
"NPI": "1255384228",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HAGAR",
"FirstName": "MARYANNE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "APRN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "SIX CORPORATE DRIVE",
"SecondLineMailingAddress": "SUITE 420",
"MailingAddressCityName": "SHELTON",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06484",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-925-9600",
"MailingAddressFaxNumber": "203-926-0594",
"FirstLinePracticeLocationAddress": "SIX CORPORATE DRIVE",
"SecondLinePracticeLocationAddress": "SUITE 420",
"PracticeLocationAddressCityName": "SHELTON",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06484",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-925-9600",
"PracticeLocationAddressFaxNumber": "203-926-0594",
"EnumerationDate": "05/18/2006",
"LastUpdateDate": "11/21/2017",
"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": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "002546",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "002546",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LG0600X",
"TaxonomyName": "Gerontology Nurse Practitioner",
"LicenseNumber": "002546",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}