{
"Npi": {
"NPI": "1649336116",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PASS",
"FirstName": "MARYANN",
"MiddleName": "H.",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "CNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KOPPERMAN",
"OtherFirstName": "MARYANN",
"OtherMiddleName": "H.",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2 MEMORIAL DR",
"SecondLineMailingAddress": "SUITE 122",
"MailingAddressCityName": "ALTON",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62002-6723",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "618-465-2550",
"MailingAddressFaxNumber": "618-462-4167",
"FirstLinePracticeLocationAddress": "2 MEMORIAL DR",
"SecondLinePracticeLocationAddress": "SUITE 122",
"PracticeLocationAddressCityName": "ALTON",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62002-6723",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "618-465-2550",
"PracticeLocationAddressFaxNumber": "618-462-4167",
"EnumerationDate": "12/29/2006",
"LastUpdateDate": "10/11/2012",
"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": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "123658",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LW0102X",
"TaxonomyName": "Women's Health Nurse Practitioner",
"LicenseNumber": "209001958",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "041272946",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "123658",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}