{
"Npi": {
"NPI": "1750611646",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BURRIDGE",
"FirstName": "KARLIJN",
"MiddleName": null,
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "PA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "UIJTERSCHOUT",
"OtherFirstName": "KARLIJN",
"OtherMiddleName": null,
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "PA",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "308 HAWTHORNE BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLEN ELLYN",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60137-4040",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "520-250-7135",
"MailingAddressFaxNumber": "630-261-9335",
"FirstLinePracticeLocationAddress": "460 QUAIL RIDGE DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WESTMONT",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60559-6145",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-986-2800",
"PracticeLocationAddressFaxNumber": "630-986-2440",
"EnumerationDate": "12/28/2009",
"LastUpdateDate": "01/20/2023",
"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": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "085.007045",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "PA08041",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "4563",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "085.007045",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}