{
"Npi": {
"NPI": "1932420239",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BLANDAMER",
"FirstName": "MILDRED",
"MiddleName": "A",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "FAMILY PMHNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BLANDAMER",
"OtherFirstName": "MILDRED (MIDGE)",
"OtherMiddleName": "A",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "APRN, CRNP",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "8108 E NORMAN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROKEN ARROW",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74014-7414",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "918-316-9353",
"MailingAddressFaxNumber": "918-517-2922",
"FirstLinePracticeLocationAddress": "BRIGHTSIDE HEALTH TELEPSYCHIATRY",
"SecondLinePracticeLocationAddress": "2261 MARKET STREET, SUITE 10222",
"PracticeLocationAddressCityName": "SAN FRANCISCO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94114",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "918-762-6604",
"PracticeLocationAddressFaxNumber": "918-762-6646",
"EnumerationDate": "06/21/2010",
"LastUpdateDate": "01/21/2025",
"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": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "5400",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "34370",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "34334",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "4405",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "154915",
"LicenseNumberStateCode": "MT",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}