{
"Npi": {
"NPI": "1952193542",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MIKOLAJ",
"FirstName": "BENJAMIN",
"MiddleName": "R",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DNP-PMHNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2545 PARADISE COVE VW APT 412",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLORADO SPRINGS",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80907-6679",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "719-444-8484",
"MailingAddressFaxNumber": "719-465-5617",
"FirstLinePracticeLocationAddress": "6160 TUTT BLVD STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COLORADO SPRINGS",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80923-3503",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "719-473-2346",
"PracticeLocationAddressFaxNumber": "719-465-5617",
"EnumerationDate": "05/20/2025",
"LastUpdateDate": "10/28/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"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": "0203768",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}