{
"Npi": {
"NPI": "1770109548",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ISAAK TSEGAI",
"FirstName": "SEMHAR",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "FNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MOGES",
"OtherFirstName": "SEMHAR",
"OtherMiddleName": "HADDISH",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "3022 S DURANGO DR STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89117-4440",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-791-1247",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3535 S INTERSTATE 35 E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DENTON",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76210-6850",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "801-633-5164",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/17/2020",
"LastUpdateDate": "10/16/2023",
"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": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "830408",
"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "112436",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}