{
"Npi": {
"NPI": "1386952919",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "EBNER",
"FirstName": "SUSAN",
"MiddleName": "V",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "R.N.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "VANBUREN",
"OtherFirstName": "SUSAN",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "150 TEJAS PL",
"SecondLineMailingAddress": "PO BOX 430",
"MailingAddressCityName": "NIPOMO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93444-9123",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-929-3211",
"MailingAddressFaxNumber": "805-929-6440",
"FirstLinePracticeLocationAddress": "1418 E MAIN ST",
"SecondLinePracticeLocationAddress": "STE 210",
"PracticeLocationAddressCityName": "SANTA MARIA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93454-4833",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-928-3678",
"PracticeLocationAddressFaxNumber": "805-928-6408",
"EnumerationDate": "09/16/2010",
"LastUpdateDate": "09/16/2010",
"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": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "279839",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "164W00000X",
"TaxonomyName": "Licensed Practical Nurse",
"LicenseNumber": "1127",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}