{
"Npi": {
"NPI": "1326811050",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DUCOMMUN",
"FirstName": "TERA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PTA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CONWELL",
"OtherFirstName": "TERA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "22 27TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW AUBURN",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54757-8787",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "715-205-8746",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1405 TRUAX BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EAU CLAIRE",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54703-1474",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "715-552-1030",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/03/2023",
"LastUpdateDate": "11/03/2023",
"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": "208100000X",
"TaxonomyName": "Physical Medicine & Rehabilitation Physician",
"LicenseNumber": "3333-19",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}