{
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"FirstLineMailingAddress": "8800 GLACIER HWY STE 227",
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"FirstLinePracticeLocationAddress": "2243 JORDAN AVE",
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"EnumerationDate": "09/26/2017",
"LastUpdateDate": "03/26/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}