{
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ANTORIAN CONSULTING SERVICES",
"LastName": null,
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"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "3545 ELLICOTT MILLS DR PMB 204",
"SecondLineMailingAddress": "PMB 204",
"MailingAddressCityName": "ELLICOTT CITY",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21043-4548",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-246-2830",
"MailingAddressFaxNumber": "410-246-2831",
"FirstLinePracticeLocationAddress": "7004 SECURITY BLVD # 300-A27",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BALTIMORE",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21244-2557",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "410-246-2830",
"PracticeLocationAddressFaxNumber": "410-246-2831",
"EnumerationDate": "10/14/2015",
"LastUpdateDate": "04/01/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOORE-HEBRON",
"AuthorizedOfficialFirstName": "AN'NITA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DRNP, FNPBC, PMHNPBC",
"AuthorizedOfficialTelephoneNumber": "410-246-2830",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "R154023",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}