{
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"EIN": null,
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"LastName": "CONRAD",
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"MiddleName": "ANNE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "MASSAGE THERAPIST",
"OtherOrgName": null,
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"OtherLastName": "CONRAD",
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"OtherCredential": "MASSAGE THERAPIST",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "4253 HIGH MESA RD SE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIO RANCHO",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87124-1428",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-414-0938",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "392 BENCHOR ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SEBASTIAN",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32958-4202",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-987-8043",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/11/2008",
"LastUpdateDate": "06/17/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
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"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "5940",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}