{
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"EIN": null,
"IsSoleProprietor": "Y",
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"LastName": "CAMPISE",
"FirstName": "GLORIA",
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"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "L.M. (LICENCED MIDWI",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GONZALEZ",
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"OtherMiddleName": "ENRIQUETA",
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"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "P.O. BOX 553",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "UKIAH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95482",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "707-391-7508",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "205 W. CLAY STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "UKIAH",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95482",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "707-621-5012",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/29/2020",
"LastUpdateDate": "06/29/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
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"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "176B00000X",
"TaxonomyName": "Midwife",
"LicenseNumber": "LM612",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}