{
"Npi": {
"NPI": "1417423914",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MATHEWS",
"FirstName": "HOLLY",
"MiddleName": "L",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "CPNP-PC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KOSIR",
"OtherFirstName": "HOLLY",
"OtherMiddleName": "L",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "CPNP-PC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1410 CRAIN HWY N STE 5A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLEN BURNIE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21061-9305",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6565 N CHARLES ST STE 306",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BALTIMORE",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21204-5804",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "443-849-4000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/23/2018",
"LastUpdateDate": "12/12/2023",
"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": "363LP0200X",
"TaxonomyName": "Pediatric Nurse Practitioner",
"LicenseNumber": "R235523",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}