{
"Npi": {
"NPI": "1295397446",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "OLLIE",
"FirstName": "JOAN",
"MiddleName": "ANNETTE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "NURSE PRACTITIONER",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "OLLIE",
"OtherFirstName": "JOAN",
"OtherMiddleName": null,
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "NURSE PRACTITIONER",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "4233 W 76TH ST APT 201",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60652-1244",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "773-677-4092",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2100 E 87TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHICAGO",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60617-3011",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "773-768-5000",
"PracticeLocationAddressFaxNumber": "773-978-8367",
"EnumerationDate": "07/08/2019",
"LastUpdateDate": "08/07/2024",
"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": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "041260739",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "209017595",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}