{
"Npi": {
"NPI": "1487025615",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FISHER",
"FirstName": "TONYA",
"MiddleName": "RENEE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "CNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SANDER",
"OtherFirstName": "TONYA",
"OtherMiddleName": "R",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "R.N.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1483 COUNTRY KNOLL PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT JOSEPH",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49085-9491",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-345-9522",
"MailingAddressFaxNumber": "269-408-1755",
"FirstLinePracticeLocationAddress": "3911 STONEGATE PARK",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT JOSEPH",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49085-9130",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "269-408-1777",
"PracticeLocationAddressFaxNumber": "269-408-1755",
"EnumerationDate": "10/14/2015",
"LastUpdateDate": "04/21/2025",
"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": "163WC0200X",
"TaxonomyName": "Critical Care Medicine Registered Nurse",
"LicenseNumber": "041.316748",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "209013250",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "4704355252",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "4704355252",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}