{
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"EIN": null,
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"FirstLineMailingAddress": "3334 SPARROW HAWK DR",
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"MailingAddressCityName": "IDAHO FALLS",
"MailingAddressStateName": "ID",
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"FirstLinePracticeLocationAddress": "3544 E 17TH ST",
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"PracticeLocationAddressCityName": "AMMON",
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"EnumerationDate": "02/06/2007",
"LastUpdateDate": "02/02/2009",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
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"LicenseNumber": "LPC3632",
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}
},
"HealthcareProviderTaxonomyGroups": null
}
}