{
"Npi": {
"NPI": "1932618113",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HENSTROM",
"FirstName": "ERICA",
"MiddleName": "ANNE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DNP, APRN, PMHNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "AGLIANO",
"OtherFirstName": "ERICA",
"OtherMiddleName": "ANNE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DNP, APRN, PMHNP-BC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 568",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STOCKTON",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84071-0516",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1481 E PIONEER RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DRAPER",
"PracticeLocationAddressStateName": "UT",
"PracticeLocationAddressPostalCode": "84020-9623",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "801-679-6669",
"PracticeLocationAddressFaxNumber": "801-203-9216",
"EnumerationDate": "09/20/2017",
"LastUpdateDate": "09/17/2026",
"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": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "8864117-4405",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "8864117-3102",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "8864117-4405",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}