{
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"FirstLineMailingAddress": "E3299 CRYSTAL RD",
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"FirstLinePracticeLocationAddress": "2446 SOUTH 102ND STREET SUITE 340",
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"EnumerationDate": "12/20/2011",
"LastUpdateDate": "03/31/2021",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
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"LicenseNumber": "928-67",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}