{
"Npi": {
"NPI": "1477676971",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HOLY FAMILY MEMORIAL, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2300 WESTERN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MANITOWOC",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54220-3712",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-320-2273",
"MailingAddressFaxNumber": "920-320-3578",
"FirstLinePracticeLocationAddress": "2300 WESTERN AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MANITOWOC",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54220-3712",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "920-320-2273",
"PracticeLocationAddressFaxNumber": "920-320-3578",
"EnumerationDate": "04/09/2007",
"LastUpdateDate": "06/16/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WIEGAND",
"AuthorizedOfficialFirstName": "DARLENE",
"AuthorizedOfficialMiddleName": "M.",
"AuthorizedOfficialTitle": "DIRECTOR OF PHARMACY",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMACIST",
"AuthorizedOfficialTelephoneNumber": "920-320-2274",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "3205-042",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}