{
"Npi": {
"NPI": "1760570998",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MARTINSEN",
"FirstName": "DELLA",
"MiddleName": "A",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PHD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MCALLISTER",
"OtherFirstName": "DELLA",
"OtherMiddleName": "A",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "PHD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2116 4TH AVE NW STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MINOT",
"MailingAddressStateName": "ND",
"MailingAddressPostalCode": "58703-2967",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "701-838-2112",
"MailingAddressFaxNumber": "701-857-5031",
"FirstLinePracticeLocationAddress": "2116 4TH AVE NW",
"SecondLinePracticeLocationAddress": "STE # 100",
"PracticeLocationAddressCityName": "MINOT",
"PracticeLocationAddressStateName": "ND",
"PracticeLocationAddressPostalCode": "58703-2967",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "701-838-2112",
"PracticeLocationAddressFaxNumber": "701-838-2115",
"EnumerationDate": "10/11/2006",
"LastUpdateDate": "03/15/2023",
"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": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "312",
"LicenseNumberStateCode": "ND",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "312",
"LicenseNumberStateCode": "ND",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}