{
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"IsOrgSubpart": "N",
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 1627",
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"MailingAddressCityName": "MOUNT VERNON",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98273-1627",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "360-708-9741",
"MailingAddressFaxNumber": "801-780-9741",
"FirstLinePracticeLocationAddress": "1911 E DIVISION ST",
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"PracticeLocationAddressCityName": "MOUNT VERNON",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98274-6703",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "360-708-9741",
"PracticeLocationAddressFaxNumber": "360-588-4192",
"EnumerationDate": "06/24/2009",
"LastUpdateDate": "04/06/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOLMES",
"AuthorizedOfficialFirstName": "ELIZABETH",
"AuthorizedOfficialMiddleName": "M.",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "ARNP",
"AuthorizedOfficialTelephoneNumber": "360-708-9741",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "AP30007181",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}