{
"Npi": {
"NPI": "1700021789",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MORTIMER",
"FirstName": "WENDY",
"MiddleName": null,
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "MSN, CRNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "103 CURLEY CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOHNTON",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19540-8744",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4201 POTTSVILLE PIKE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "READING",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19605-1219",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "610-921-5811",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/04/2008",
"LastUpdateDate": "02/19/2021",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "SP023203",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LA2200X",
"TaxonomyName": "Adult Health Nurse Practitioner",
"LicenseNumber": "SP007258",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}