{
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"FirstLineMailingAddress": "PO BOX 628",
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"EnumerationDate": "10/01/2008",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "PORSUELO",
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"AuthorizedOfficialCredential": "NURSE PRACTITIONER",
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"TaxonomyName": "Gerontology Nurse Practitioner",
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"LicenseNumberStateCode": "CA",
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}
},
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}
}
}
}