{
"Npi": {
"NPI": "1972101962",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DAVIS",
"FirstName": "DONNA",
"MiddleName": "PEACOCK",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1308 HIGHWAY 33 S",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLOQUET",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55720-2653",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "218-878-0676",
"MailingAddressFaxNumber": "218-879-0087",
"FirstLinePracticeLocationAddress": "1308 HIGHWAY 33 S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLOQUET",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55720-2653",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "218-878-0676",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/13/2020",
"LastUpdateDate": "10/13/2020",
"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": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "115913",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}