{
"Npi": {
"NPI": "1295197069",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MARSHALL",
"FirstName": "SAMANTHA",
"MiddleName": "MARIE PERSSON",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "FNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PERSSON",
"OtherFirstName": "SAMANTHA",
"OtherMiddleName": "MARIE",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "FNP-BC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2790 GODWIN BLVD STE 375",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SUFFOLK",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23434-8175",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-934-4646",
"MailingAddressFaxNumber": "757-995-1944",
"FirstLinePracticeLocationAddress": "2790 GODWIN BLVD STE 375",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SUFFOLK",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23434-8175",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "757-934-4646",
"PracticeLocationAddressFaxNumber": "757-995-1944",
"EnumerationDate": "03/22/2016",
"LastUpdateDate": "01/25/2024",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "0024173410",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}