{
"Npi": {
"NPI": "1477474716",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DIMAANO",
"FirstName": "MARY",
"MiddleName": "NICOLE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PHARMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DIMAANO",
"OtherFirstName": "NICOLE",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PHARMD",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "632 CRAIG AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WENATCHEE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98801-4505",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "632 CRAIG AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WENATCHEE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98801-4505",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-335-7327",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/23/2026",
"LastUpdateDate": "07/23/2026",
"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": "1835C0207X",
"TaxonomyName": "Compounded Sterile Preparations Pharmacist",
"LicenseNumber": "PHPC.PH.60951015",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}