{
"Npi": {
"NPI": "1326073040",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WALLACE",
"FirstName": "NICKOLA",
"MiddleName": "KIM",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "CRNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MCCARTY",
"OtherFirstName": "NICKOLA",
"OtherMiddleName": "KIM",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1803 MOUNT ROSE AVE",
"SecondLineMailingAddress": "SUITE B3",
"MailingAddressCityName": "YORK",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17403-3026",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "717-851-1405",
"MailingAddressFaxNumber": "717-851-6969",
"FirstLinePracticeLocationAddress": "1001 S GEORGE ST",
"SecondLinePracticeLocationAddress": "BLDG MKB",
"PracticeLocationAddressCityName": "YORK",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "17405",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "717-851-2521",
"PracticeLocationAddressFaxNumber": "717-851-3535",
"EnumerationDate": "07/11/2006",
"LastUpdateDate": "07/09/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "TP006718B",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}