{
"Npi": {
"NPI": "1912462870",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ISSAC",
"FirstName": "JANZE",
"MiddleName": "MARIUM",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "ANP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KOSHY",
"OtherFirstName": "JANZE",
"OtherMiddleName": "MARIUM",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "650 S RIVER RD UNIT 404",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DES PLAINES",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60016-8430",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "845-480-2862",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1550 S INDIANA AVE STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHICAGO",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60605-4835",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "845-480-2862",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/05/2019",
"LastUpdateDate": "05/07/2019",
"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": "363LG0600X",
"TaxonomyName": "Gerontology Nurse Practitioner",
"LicenseNumber": "209017708",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}