{
"Npi": {
"NPI": "1184552713",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KONDOR",
"FirstName": "DAWN",
"MiddleName": "RENEE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "OD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KONDOR",
"OtherFirstName": "DAWN",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "OD",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "12345 DOWNES ST NE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOWELL",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49331-9762",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "616-469-7109",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5500 ARMSTRONG RD BLDG 3",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BATTLE CREEK",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49037-7314",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "269-966-5600",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/12/2026",
"LastUpdateDate": "05/12/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": null,
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}