{
"Npi": {
"NPI": "1538332747",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KUEBLER",
"FirstName": "TIFFANY",
"MiddleName": "HEIN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HEIN",
"OtherFirstName": "TIFFANY",
"OtherMiddleName": "DENA",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PA-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "22 SOUTH GREENE ST",
"SecondLineMailingAddress": "R ADAMS COWLEY SHOCK TRAUMA CENTER",
"MailingAddressCityName": "BALTIMORE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21201",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-328-7056",
"MailingAddressFaxNumber": "410-328-8953",
"FirstLinePracticeLocationAddress": "22 S GREENE ST",
"SecondLinePracticeLocationAddress": "R ADAMS COWLEY SHOCK TRAUMA CENTER",
"PracticeLocationAddressCityName": "BALTIMORE",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21201",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "410-328-8976",
"PracticeLocationAddressFaxNumber": "410-328-8953",
"EnumerationDate": "04/09/2008",
"LastUpdateDate": "02/20/2017",
"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": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "C03638",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}