{
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "2365 LAKE GEORGE DR NW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CEDAR",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55011-4216",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-516-4386",
"MailingAddressFaxNumber": "888-333-1427",
"FirstLinePracticeLocationAddress": "23624 SAINT FRANCIS BLVD NW STE 1",
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"PracticeLocationAddressCityName": "SAINT FRANCIS",
"PracticeLocationAddressStateName": "MN",
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"PracticeLocationAddressFaxNumber": "888-333-1427",
"EnumerationDate": "04/13/2016",
"LastUpdateDate": "04/13/2016",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NUDD",
"AuthorizedOfficialFirstName": "RACHEL",
"AuthorizedOfficialMiddleName": "SIMONE",
"AuthorizedOfficialTitle": "OWNER/ LICENSED ACUPUNCTURIST",
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"AuthorizedOfficialCredential": "LAC",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": "1594",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}