{
"Npi": {
"NPI": "1508110347",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PANICKER",
"FirstName": "LATHA",
"MiddleName": "S",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "APN-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PANICKER",
"OtherFirstName": "LATHA",
"OtherMiddleName": "S",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "APN-BC",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "800 S WILMETTE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTMONT",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60559-8623",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-696-7594",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "977 N OAKLAWN AVE",
"SecondLinePracticeLocationAddress": "SUITE 104",
"PracticeLocationAddressCityName": "ELMHURST",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60126-1045",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "800-683-7861",
"PracticeLocationAddressFaxNumber": "888-856-4648",
"EnumerationDate": "11/01/2012",
"LastUpdateDate": "11/01/2012",
"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": "363LA2200X",
"TaxonomyName": "Adult Health Nurse Practitioner",
"LicenseNumber": "209.009961",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}