{
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"FirstLineMailingAddress": "5280 S COMMERCE DR STE E190",
"SecondLineMailingAddress": null,
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"MailingAddressPostalCode": "84107-5321",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "801-266-2000",
"MailingAddressFaxNumber": "877-896-8171",
"FirstLinePracticeLocationAddress": "5280 S COMMERCE DR STE E190",
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"PracticeLocationAddressFaxNumber": "877-896-8171",
"EnumerationDate": "02/18/2014",
"LastUpdateDate": "09/12/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREENWOOD",
"AuthorizedOfficialFirstName": "NIKKI",
"AuthorizedOfficialMiddleName": null,
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"AuthorizedOfficialCredential": "FNP - BC",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Addiction Medicine (Family Medicine) Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}