{
"Npi": {
"NPI": "1629121223",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUSAN WICKE, MD, PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "112 SWIFT AVENUE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DURHAM",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27705",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-493-3932",
"MailingAddressFaxNumber": "919-493-3932",
"FirstLinePracticeLocationAddress": "112 SWIFT AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DURHAM",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27705-4800",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "919-493-3932",
"PracticeLocationAddressFaxNumber": "919-493-3932",
"EnumerationDate": "01/19/2007",
"LastUpdateDate": "08/23/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WICKE",
"AuthorizedOfficialFirstName": "SUSAN",
"AuthorizedOfficialMiddleName": "HOLLY",
"AuthorizedOfficialTitle": "PSYCHIATRIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "919-493-3932",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "36618",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}