{
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"FirstLineMailingAddress": "2050 BRETON RD SE STE 109",
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"MailingAddressCityName": "GRAND RAPIDS",
"MailingAddressStateName": "MI",
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"FirstLinePracticeLocationAddress": "2050 BRETON RD SE STE 109",
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"PracticeLocationAddressCityName": "GRAND RAPIDS",
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"EnumerationDate": "07/14/2020",
"LastUpdateDate": "07/14/2020",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"LicenseNumber": "7501004855",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}