{
"Npi": {
"NPI": "1033853783",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTHWEST VITALITY GROUP",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"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": "3 MONROW PKWY",
"SecondLineMailingAddress": "STE P #714",
"MailingAddressCityName": "LAKE OSWEGO",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97035",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-477-5084",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9233 SW 52ND AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PORTLAND",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97219-5003",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-757-8535",
"PracticeLocationAddressFaxNumber": "971-223-0949",
"EnumerationDate": "04/27/2022",
"LastUpdateDate": "04/27/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FAY",
"AuthorizedOfficialFirstName": "HOLLY",
"AuthorizedOfficialMiddleName": "ANNE",
"AuthorizedOfficialTitle": "OWNER/PROVIDER/CMO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DNP, APRN, FNP-A",
"AuthorizedOfficialTelephoneNumber": "503-757-8535",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}