{
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"EIN": null,
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"OtherLastName": "GREEN",
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"FirstLineMailingAddress": "3264 N EVERGREEN DR NE",
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"MailingAddressCityName": "GRAND RAPIDS",
"MailingAddressStateName": "MI",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "616-363-7339",
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"FirstLinePracticeLocationAddress": "1234 NAPIER AVE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "269-983-8300",
"PracticeLocationAddressFaxNumber": "269-983-6965",
"EnumerationDate": "06/19/2006",
"LastUpdateDate": "09/14/2018",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Diagnostic Radiology Physician",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}