{
"Npi": {
"NPI": "1457809881",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FANNIN",
"FirstName": "KEITH",
"MiddleName": "RAY",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "RN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "ONE MEDICAL CENTER DRIVE",
"SecondLineMailingAddress": "DARTMOUTH HITCHCOCK - GENERAL SURGERY",
"MailingAddressCityName": "LEBANON",
"MailingAddressStateName": "NH",
"MailingAddressPostalCode": "03756",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "603-650-7903",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "ONE MEDICAL CENTER DRIVE",
"SecondLinePracticeLocationAddress": "DARTMOUTH HITCHCOCK - GENERAL SURGERY",
"PracticeLocationAddressCityName": "LEBANON",
"PracticeLocationAddressStateName": "NH",
"PracticeLocationAddressPostalCode": "03756",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "603-650-7903",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/14/2016",
"LastUpdateDate": "03/20/2018",
"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": "163WC0200X",
"TaxonomyName": "Critical Care Medicine Registered Nurse",
"LicenseNumber": "RN.372827",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "077205-23",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "077205-23",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}