{
"Npi": {
"NPI": "1548529084",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MAUGER",
"FirstName": "BEVERLY",
"MiddleName": "LYNN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "NP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HOWELL",
"OtherFirstName": "BEVERLY",
"OtherMiddleName": "L",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "8488 FRITZ ROAD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT WAYNE",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46818",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "260-450-9665",
"MailingAddressFaxNumber": "888-803-6843",
"FirstLinePracticeLocationAddress": "6326 CONSTITUTION DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FT WAYNE",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "46804",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "260-515-3275",
"PracticeLocationAddressFaxNumber": "888-803-6843",
"EnumerationDate": "05/03/2012",
"LastUpdateDate": "12/08/2025",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "71004010A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}