{
"Npi": {
"NPI": "1669024048",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ARCHIE",
"FirstName": "ERRYNNE",
"MiddleName": "REBEKKAH",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "ARCHIE",
"OtherFirstName": "ERRYNE",
"OtherMiddleName": "REBEKKA LEPLAT",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "1506 BROOK PARK WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROSEVILLE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95747-7340",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "916-759-2815",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1620 SANTA CLARA DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROSEVILLE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95661-3558",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "916-862-5243",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/15/2019",
"LastUpdateDate": "04/23/2025",
"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": "225400000X",
"TaxonomyName": "Rehabilitation Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}