{
"Npi": {
"NPI": "1710535505",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LAWRENCE",
"FirstName": "LUCILLE",
"MiddleName": "ARSUA",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "STALLWORTH",
"OtherFirstName": "LUCILLE",
"OtherMiddleName": "ARSUA",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "733 SKIMMER DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PATTERSON",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95363-8735",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "519-717-0063",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3014 MACARTHUR BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OAKLAND",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94602-3212",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "510-698-4412",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/26/2019",
"LastUpdateDate": "11/20/2019",
"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": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "KK375277",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}