{
"Npi": {
"NPI": "1912259441",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ROBERTA L. FENNIG DO PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 4",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTA TERESA",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "88008-0004",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "575-589-1770",
"MailingAddressFaxNumber": "575-589-1799",
"FirstLinePracticeLocationAddress": "5305 MCNUTT RD",
"SecondLinePracticeLocationAddress": "SUITE H",
"PracticeLocationAddressCityName": "SANTA TERESA",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "88008-9685",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "575-589-1770",
"PracticeLocationAddressFaxNumber": "575-589-1799",
"EnumerationDate": "10/08/2012",
"LastUpdateDate": "10/08/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FENNIG",
"AuthorizedOfficialFirstName": "ROBERTA",
"AuthorizedOfficialMiddleName": "LEE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "915-494-1237",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "A167712",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}