{
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"FirstLineMailingAddress": "13805 60TH AVE N",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PLYMOUTH",
"MailingAddressStateName": "MN",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-839-1449",
"MailingAddressFaxNumber": "763-550-9398",
"FirstLinePracticeLocationAddress": "2100 PLYMOUTH AVE N",
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"EnumerationDate": "05/07/2007",
"LastUpdateDate": "09/24/2015",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GARRETT-AKINSANYA",
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"Taxonomies": {
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"LicenseNumber": "LP4105",
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}