{
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"EIN": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": "N.P.",
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"OtherLastName": "GABICA",
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"OtherCredential": "MSN, RN, ACNP-BC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "3729 E TAHITI DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MERIDIAN",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83646-5343",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": "497-106-0039",
"FirstLinePracticeLocationAddress": "3729 E TAHITI DR",
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"PracticeLocationAddressCityName": "MERIDIAN",
"PracticeLocationAddressStateName": "ID",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-880-3196",
"PracticeLocationAddressFaxNumber": "497-106-0039",
"EnumerationDate": "05/18/2012",
"LastUpdateDate": "06/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "NP-1162A",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}