{
"Npi": {
"NPI": "1649421884",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "D.B.A MOM'S MASTECTOMY",
"LastName": null,
"FirstName": null,
"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": "415 N 66TH ST.",
"SecondLineMailingAddress": "SUITE 8",
"MailingAddressCityName": "LINCOLN",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68505",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "402-464-6001",
"MailingAddressFaxNumber": "402-464-6669",
"FirstLinePracticeLocationAddress": "415 N 66TH ST",
"SecondLinePracticeLocationAddress": "SUITE 8",
"PracticeLocationAddressCityName": "LINCOLN",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "68505-2431",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "402-464-6001",
"PracticeLocationAddressFaxNumber": "402-464-6669",
"EnumerationDate": "10/07/2008",
"LastUpdateDate": "01/26/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HAWKINS",
"AuthorizedOfficialFirstName": "JENNIFER",
"AuthorizedOfficialMiddleName": "LYNN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MISS",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "402-464-6001",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}