{
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "14100 N 83RD AVE STE 160",
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"MailingAddressCityName": "PEORIA",
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"MailingAddressPostalCode": "85381-5653",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "623-233-1610",
"FirstLinePracticeLocationAddress": "14100 N 83RD AVE STE 160",
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"PracticeLocationAddressCityName": "PEORIA",
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"PracticeLocationAddressFaxNumber": "623-233-1610",
"EnumerationDate": "04/04/2018",
"LastUpdateDate": "01/14/2019",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ILYUSHENKO",
"AuthorizedOfficialFirstName": "YULIYA",
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"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "323-704-5369",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
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"PrimaryTaxonomySwitch": "N"
},
{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}