{
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"FirstLineMailingAddress": "175 OLD CORVALLIS RD",
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"MailingAddressCityName": "HAMILTON",
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"MailingAddressFaxNumber": "406-540-1221",
"FirstLinePracticeLocationAddress": "813 S 1ST ST",
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"PracticeLocationAddressCityName": "HAMILTON",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "64-361-0327",
"PracticeLocationAddressFaxNumber": "406-540-1221",
"EnumerationDate": "10/10/2019",
"LastUpdateDate": "01/09/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": [
{
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"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "176B00000X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}