{
"Npi": {
"NPI": "1639637176",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HUDDLESTON",
"FirstName": "SHANNON",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "848 OGDEN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BENTON HARBOR",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49022-5135",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "269-759-4149",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1385 E EMPIRE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BENTON HARBOR",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49022-2037",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "269-925-0033",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/04/2019",
"LastUpdateDate": "03/04/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "376K00000X",
"TaxonomyName": "Nurse's Aide",
"LicenseNumber": "44985",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}