{
"Npi": {
"NPI": "1891427118",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MACFAWN",
"FirstName": "LAURYN",
"MiddleName": "GRACE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "CRNA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "RUCKERT",
"OtherFirstName": "LAURYN",
"OtherMiddleName": "GRACE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "RN",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "401 AMBERSON AVE APT 137",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PITTSBURGH",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15232-1456",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "240-362-3254",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "12351 PERRY HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WEXFORD",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "15090-8344",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "412-359-6581",
"PracticeLocationAddressFaxNumber": "412-359-3483",
"EnumerationDate": "06/27/2022",
"LastUpdateDate": "10/18/2024",
"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": "367500000X",
"TaxonomyName": "Certified Registered Nurse Anesthetist",
"LicenseNumber": "RN770389",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}