{
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"MailingAddressStateName": "MN",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "707 HIGHWAY 33 S",
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"EnumerationDate": "02/19/2025",
"LastUpdateDate": "02/19/2025",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "CONLEY",
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"AuthorizedOfficialTelephoneNumber": "715-923-3682",
"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}