{
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"FirstLineMailingAddress": "203 S ROLLIE AVE",
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"MailingAddressCityName": "FORT LUPTON",
"MailingAddressStateName": "CO",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "303-697-2583",
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"FirstLinePracticeLocationAddress": "1950 REDTAIL HAWK DR",
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"PracticeLocationAddressCityName": "ESTES PARK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-698-2753",
"PracticeLocationAddressFaxNumber": "970-577-3464",
"EnumerationDate": "11/30/2019",
"LastUpdateDate": "07/28/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
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"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}