{
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"FirstLineMailingAddress": "PO BOX 860013",
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"MailingAddressCityName": "MINNEAPOLIS",
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"MailingAddressTelephoneNumber": "307-746-6720",
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"FirstLinePracticeLocationAddress": "1121 WASHINGTON BLVD",
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"EnumerationDate": "05/26/2015",
"LastUpdateDate": "06/04/2021",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WORSLEY",
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"AuthorizedOfficialTelephoneNumber": "605-644-4091",
"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}