{
"Npi": {
"NPI": "1417104407",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MICHAEL",
"FirstName": "DAVID",
"MiddleName": "CHRISTOPHER",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "CRNA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MALISA",
"OtherFirstName": "DAVID",
"OtherMiddleName": "MICHAEL",
"OtherNamePrefix": "MR.",
"OtherNameSuffix": null,
"OtherCredential": "CRNA",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "6320 CHADFORD DR",
"SecondLineMailingAddress": "APT 2003",
"MailingAddressCityName": "RALEIGH",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27612-7104",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-376-7085",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "250 SMITH CHURCH RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROANOKE RAPIDS",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27870-4914",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "252-535-8437",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/21/2008",
"LastUpdateDate": "05/31/2026",
"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": "367500000X",
"TaxonomyName": "Certified Registered Nurse Anesthetist",
"LicenseNumber": "189534",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}