{
"Npi": {
"NPI": "1508847286",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "COMER-CONCORDIA",
"FirstName": "STEPHANIE",
"MiddleName": "SUSAN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "CRNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "COMER",
"OtherFirstName": "STEPHANIE",
"OtherMiddleName": "SUSAN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "140 THOMAS JOHNSON DR",
"SecondLineMailingAddress": "SUITE 202",
"MailingAddressCityName": "FREDERICK",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21702-4475",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-694-7788",
"MailingAddressFaxNumber": "301-694-3184",
"FirstLinePracticeLocationAddress": "140 THOMAS JOHNSON DR",
"SecondLinePracticeLocationAddress": "SUITE 202",
"PracticeLocationAddressCityName": "FREDERICK",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21702-4475",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-694-3184",
"PracticeLocationAddressFaxNumber": "301-694-3184",
"EnumerationDate": "11/09/2005",
"LastUpdateDate": "08/12/2008",
"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": "R125748",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "SP009117",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}