{
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"EIN": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "305 S CLARK ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MAYVILLE",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53050-1488",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-356-0681",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "201 PRAIRIE VIEW DR",
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"PracticeLocationAddressCityName": "BEAVER DAM",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/09/2009",
"LastUpdateDate": "02/10/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SPADARO",
"AuthorizedOfficialFirstName": "VITTORIO",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "920-356-0681",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}