{
"Npi": {
"NPI": "1811647829",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PHILIZAIRE CAMACHO",
"FirstName": "REGINE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "APRN, MSN, AGPCNP-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CAMACHO",
"OtherFirstName": "REGINE",
"OtherMiddleName": "PHILIZAIRE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "APRN, MSN, AGPCNP-C",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "6352 N LINCOLN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60659-1213",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "872-208-3095",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "259 E ERIE ST STE 1950",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHICAGO",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60611-3907",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "312-926-3185",
"PracticeLocationAddressFaxNumber": "312-926-7382",
"EnumerationDate": "03/24/2022",
"LastUpdateDate": "01/01/2025",
"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": "363LA2200X",
"TaxonomyName": "Adult Health Nurse Practitioner",
"LicenseNumber": "209.024946",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "209024946",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}