{
"Npi": {
"NPI": "1992144489",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HALL",
"FirstName": "VIRGINIA",
"MiddleName": "DENISE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "CNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WHITE",
"OtherFirstName": "VIRGINIA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "6552 AGNES AVE # 4319",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH HOLLYWOOD",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91606-1517",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "419-834-3441",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1201 S VICTORY BLVD STE 206",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BURBANK",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91502-2793",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "747-271-2701",
"PracticeLocationAddressFaxNumber": "310-693-5384",
"EnumerationDate": "06/18/2013",
"LastUpdateDate": "11/25/2024",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "95010976",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "95010976",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}