{
"Npi": {
"NPI": "1629203468",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JACOBS",
"FirstName": "MICHAELA",
"MiddleName": "HANEY",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HANEY",
"OtherFirstName": "MICHAELA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "4545 ALAMEDA BLVD NE",
"SecondLineMailingAddress": "SUITE G",
"MailingAddressCityName": "ALBUQUERQUE",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87113-1591",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-896-2900",
"MailingAddressFaxNumber": "505-938-4198",
"FirstLinePracticeLocationAddress": "4545 ALAMEDA BLVD NE",
"SecondLinePracticeLocationAddress": "SUITE G",
"PracticeLocationAddressCityName": "ALBUQUERQUE",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "87113-1591",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-896-2900",
"PracticeLocationAddressFaxNumber": "505-938-4198",
"EnumerationDate": "05/22/2009",
"LastUpdateDate": "05/12/2015",
"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": "207ZD0900X",
"TaxonomyName": "Dermatopathology (Pathology) Physician",
"LicenseNumber": "MD2013-0154",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207N00000X",
"TaxonomyName": "Dermatology Physician",
"LicenseNumber": "MD20130154",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}