{
"Npi": {
"NPI": "1356776918",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ROSE",
"FirstName": "RILEY",
"MiddleName": "D",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "AG/ACNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "330 N WABASH AVE",
"SecondLineMailingAddress": "STE G20",
"MailingAddressCityName": "MARION",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46952-2696",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "765-660-7600",
"MailingAddressFaxNumber": "765-651-7313",
"FirstLinePracticeLocationAddress": "1406 W BELLA DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARION",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "46953-5229",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "765-660-7720",
"PracticeLocationAddressFaxNumber": "765-662-4493",
"EnumerationDate": "09/13/2013",
"LastUpdateDate": "10/21/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "163WW0000X",
"TaxonomyName": "Wound Care Registered Nurse",
"LicenseNumber": "28161345A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LG0600X",
"TaxonomyName": "Gerontology Nurse Practitioner",
"LicenseNumber": "741004600A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LA2100X",
"TaxonomyName": "Acute Care Nurse Practitioner",
"LicenseNumber": "741004600A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}