{
"Npi": {
"NPI": "1306812235",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "STEWART",
"FirstName": "JEANNE",
"MiddleName": "MARIE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "P.A.-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KNUDSVIG",
"OtherFirstName": "JEANNE",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "667 KINGSBOROUGH SQ STE 101",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHESAPEAKE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23320-4999",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-842-4481",
"MailingAddressFaxNumber": "757-312-3135",
"FirstLinePracticeLocationAddress": "111 MEDICAL PKWY FL 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHESAPEAKE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23320-0302",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "757-312-4047",
"PracticeLocationAddressFaxNumber": "757-410-0339",
"EnumerationDate": "02/28/2006",
"LastUpdateDate": "06/20/2024",
"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": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "0010-08589",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "0110006165",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "PA04936",
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "0472P",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "PA60698597",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}