{
"Npi": {
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LASER COSMETIC WELLNES CENTER",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7901 SKANSIE AVE STE 105",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GIG HARBOR",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98335-7497",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "253-858-2408",
"MailingAddressFaxNumber": "253-432-4050",
"FirstLinePracticeLocationAddress": "7901 SKANSIE AVE STE 105",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GIG HARBOR",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98335-7497",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "253-858-2408",
"PracticeLocationAddressFaxNumber": "253-432-4050",
"EnumerationDate": "08/30/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SWAYZER",
"AuthorizedOfficialFirstName": "DYNA",
"AuthorizedOfficialMiddleName": "SWAYZER",
"AuthorizedOfficialTitle": "ADMINSTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "253-278-5741",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": "AP30006085",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}