{
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"NamePrefix": null,
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"FirstLineMailingAddress": "656 NW MIRADOR PL",
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"MailingAddressTelephoneNumber": "541-552-0386",
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"EnumerationDate": "05/06/2009",
"LastUpdateDate": "11/19/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EDWARDS",
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"AuthorizedOfficialCredential": "FNP",
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{
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"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
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}
}