{
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"FirstLineMailingAddress": "1850 E SAHARA AVE STE 202",
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"MailingAddressStateName": "NV",
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"FirstLinePracticeLocationAddress": "1850 E SAHARA AVE STE 202",
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"PracticeLocationAddressFaxNumber": "702-850-2965",
"EnumerationDate": "03/08/2018",
"LastUpdateDate": "03/08/2018",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "HULSEBOS",
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"AuthorizedOfficialCredential": "DPM",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
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"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}
}
}