{
"Npi": {
"NPI": "1568903300",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BORUC",
"FirstName": "AGNIESZKA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "N.P.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1851 SILVER CROSS BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW LENOX",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60451",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-300-3080",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "18350 KEDZIE AVE",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "HOMEWOOD",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60430-2700",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-365-1055",
"PracticeLocationAddressFaxNumber": "708-799-1249",
"EnumerationDate": "03/13/2017",
"LastUpdateDate": "04/02/2020",
"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": "209.015736",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}