{
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"FirstLineMailingAddress": "7635 148TH ST W # 240",
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"MailingAddressStateName": "MN",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "1300 BOLLENBACHER DR STE B",
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"PracticeLocationAddressCityName": "NORTHFIELD",
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"EnumerationDate": "06/21/2024",
"LastUpdateDate": "06/21/2024",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SABOUTEY",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Nurse Practitioner",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}