{
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"EIN": null,
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"FirstLineMailingAddress": "PO BOX 8423",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GREENVILLE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27835-8423",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "252-847-2181",
"MailingAddressFaxNumber": "252-847-2213",
"FirstLinePracticeLocationAddress": "2100 STANTONSBURG ROAD",
"SecondLinePracticeLocationAddress": "ECHI AT PCMH",
"PracticeLocationAddressCityName": "GREENVILLE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "252-847-2181",
"PracticeLocationAddressFaxNumber": "252-847-2213",
"EnumerationDate": "05/20/2009",
"LastUpdateDate": "05/20/2009",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "5004377",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}