{
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"FirstLineMailingAddress": "530 N 4TH ST",
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"MailingAddressStateName": "MN",
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"FirstLinePracticeLocationAddress": "522 MAIN ST",
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"PracticeLocationAddressCityName": "HENDERSON",
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"PracticeLocationAddressTelephoneNumber": "507-858-3019",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/16/2018",
"LastUpdateDate": "02/27/2024",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"LicenseNumber": "3595",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}