{
"Npi": {
"NPI": "1346481389",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "RILEY",
"FirstName": "MARYELLEN",
"MiddleName": "AGNES",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "WHNP, RN,C, MS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1252 N 22ND ST UNIT A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LARAMIE",
"MailingAddressStateName": "WY",
"MailingAddressPostalCode": "82072-5306",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "307-745-5364",
"MailingAddressFaxNumber": "307-745-4164",
"FirstLinePracticeLocationAddress": "1252 N 22ND ST UNIT A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LARAMIE",
"PracticeLocationAddressStateName": "WY",
"PracticeLocationAddressPostalCode": "82072",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "307-745-5364",
"PracticeLocationAddressFaxNumber": "307-745-4164",
"EnumerationDate": "03/22/2009",
"LastUpdateDate": "06/25/2018",
"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": "363LW0102X",
"TaxonomyName": "Women's Health Nurse Practitioner",
"LicenseNumber": "102244",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LW0102X",
"TaxonomyName": "Women's Health Nurse Practitioner",
"LicenseNumber": "41390.1753",
"LicenseNumberStateCode": "WY",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}