{
"Npi": {
"NPI": "1609479740",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "STEPHAN",
"FirstName": "TARA",
"MiddleName": "LYNN",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "STEPHAN",
"OtherFirstName": "TARA",
"OtherMiddleName": "LYNN",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "919 STINSON DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAGINAW",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48604-2136",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "919 STINSON DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAGINAW",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48604-2136",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "616-302-5994",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/20/2020",
"LastUpdateDate": "04/26/2021",
"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": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": "390200000X",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "F03210972",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}