{
"Npi": {
"NPI": "1467985143",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "RUKSTELO",
"FirstName": "ALEXANDRA",
"MiddleName": "MONICA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "D.O.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "OSTROMECKI",
"OtherFirstName": "ALEXANDRA",
"OtherMiddleName": "MONICA",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "D.O.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "3010 BEARD RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NAPA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94558-3442",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "707-255-8825",
"MailingAddressFaxNumber": "707-252-9325",
"FirstLinePracticeLocationAddress": "3421 VILLA LN STE 2B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NAPA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94558-3060",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "72-555-4547",
"PracticeLocationAddressFaxNumber": "707-255-5411",
"EnumerationDate": "04/10/2017",
"LastUpdateDate": "03/23/2023",
"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": "208100000X",
"TaxonomyName": "Physical Medicine & Rehabilitation Physician",
"LicenseNumber": "5101024481",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208100000X",
"TaxonomyName": "Physical Medicine & Rehabilitation Physician",
"LicenseNumber": "20A20612",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}