{
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"FirstName": null,
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"FirstLineMailingAddress": "1023 E 22ND ST",
"SecondLineMailingAddress": null,
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"MailingAddressStateName": "MN",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-246-4868",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1023 E 22ND ST",
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"PracticeLocationAddressCityName": "MINNEAPOLIS",
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"PracticeLocationAddressTelephoneNumber": "920-246-4868",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/06/2026",
"LastUpdateDate": "03/06/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOHAMED",
"AuthorizedOfficialFirstName": "LIBAN",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "920-246-4868",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251B00000X",
"TaxonomyName": "Case Management Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}