{
"Npi": {
"NPI": "1255531372",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ERICSON HAND AND NERVE CENTER, PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6100 219TH ST SW",
"SecondLineMailingAddress": "SUITE 540",
"MailingAddressCityName": "MOUNTLAKE TERRACE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98043-2222",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-776-4444",
"MailingAddressFaxNumber": "425-328-1540",
"FirstLinePracticeLocationAddress": "6100 219TH ST SW",
"SecondLinePracticeLocationAddress": "SUITE 540",
"PracticeLocationAddressCityName": "MOUNTLAKE TERRACE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98043-2222",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "425-776-4444",
"PracticeLocationAddressFaxNumber": "425-328-1540",
"EnumerationDate": "07/18/2007",
"LastUpdateDate": "01/14/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ERICSON",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "BURTON",
"AuthorizedOfficialTitle": "MEMBER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "425-776-4444",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "MD00044072",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}