{
"Npi": {
"NPI": "1609768076",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CANN",
"FirstName": "MIKAYLA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DNP, FNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "W6428 SONNY DR APT 222",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MENASHA",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54952-0047",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "608-213-2014",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "THEDACARE REGIONAL MEDICAL CENTER-APPLETON",
"SecondLinePracticeLocationAddress": "1818 N MEADE STREET",
"PracticeLocationAddressCityName": "APPLETON",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54911",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "920-454-2169",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/18/2025",
"LastUpdateDate": "07/18/2025",
"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": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "17114-33",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}