{
"Npi": {
"NPI": "1568366276",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WOODWARD",
"FirstName": "NICOLE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GARY",
"OtherFirstName": "NICOLE",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "107 SANCOMB RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHATEAUGAY",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "12920-2603",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "518-651-6076",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "42 RIVER ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHATEAUGAY",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "12920-2002",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "518-497-6611",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/06/2026",
"LastUpdateDate": "10/06/2026",
"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": "164W00000X",
"TaxonomyName": "Licensed Practical Nurse",
"LicenseNumber": "343356",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}