{
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"FirstLineMailingAddress": "4729 TIEMANN AVE",
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"MailingAddressCityName": "SAINT LOUIS",
"MailingAddressStateName": "MO",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "801 N. 11TH STREET",
"SecondLinePracticeLocationAddress": "ST. LOUIS PUBLIC SCHOOLS",
"PracticeLocationAddressCityName": "SAINT LOUIS",
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"PracticeLocationAddressTelephoneNumber": "314-231-3720",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/02/2016",
"LastUpdateDate": "11/03/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171W00000X",
"TaxonomyName": "Contractor",
"LicenseNumber": null,
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}