{
"Npi": {
"NPI": "1477132728",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ELYEA",
"FirstName": "KATARINA",
"MiddleName": "NICOLE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "NURSE PRACTITIONER",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "TREIBER",
"OtherFirstName": "KATARINA",
"OtherMiddleName": "NICOLE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 735044",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60673-5044",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "800-326-2250",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6611 SPRING ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MOUNT PLEASANT",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53406-2632",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-504-3100",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/05/2021",
"LastUpdateDate": "12/18/2025",
"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": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "10516",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363LG0600X",
"TaxonomyName": "Gerontology Nurse Practitioner",
"LicenseNumber": "10516-33",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LG0600X",
"TaxonomyName": "Gerontology Nurse Practitioner",
"LicenseNumber": "209023339",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}