{
"Npi": {
"NPI": "1285121988",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PETERSON",
"FirstName": "JENNIFER",
"MiddleName": "LYNN",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "APRN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2631 WILLIAMSBURG AVENUE",
"SecondLineMailingAddress": "SUITE 202",
"MailingAddressCityName": "GENEVA",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60134-1111",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-981-4742",
"MailingAddressFaxNumber": "630-402-9169",
"FirstLinePracticeLocationAddress": "2631 WILLIAMSBURG AVENUE",
"SecondLinePracticeLocationAddress": "SUITE 202",
"PracticeLocationAddressCityName": "GENEVA",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60134-1111",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "815-981-4742",
"PracticeLocationAddressFaxNumber": "630-402-9169",
"EnumerationDate": "04/18/2018",
"LastUpdateDate": "03/23/2023",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "209.017872",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "163WG0000X",
"TaxonomyName": "General Practice Registered Nurse",
"LicenseNumber": "041369391",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}