{
"Npi": {
"NPI": "1720623457",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TIMM",
"FirstName": "LESLIE",
"MiddleName": "L",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "BSN, RN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HAEFFNER",
"OtherFirstName": "LESLIE",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "BSN,RN",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "609 WHITNEY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PENDER",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68047-5036",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "402-385-3244",
"MailingAddressFaxNumber": "402-385-3342",
"FirstLinePracticeLocationAddress": "609 WHITNEY ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PENDER",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "68047-5036",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "402-385-3244",
"PracticeLocationAddressFaxNumber": "402-385-3342",
"EnumerationDate": "11/18/2019",
"LastUpdateDate": "11/18/2019",
"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": "163WS0200X",
"TaxonomyName": "School Registered Nurse",
"LicenseNumber": "57409",
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}