{
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"FirstLineMailingAddress": "PO BOX 935",
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"MailingAddressCityName": "NEWAYGO",
"MailingAddressStateName": "MI",
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"FirstLinePracticeLocationAddress": "9132 S MASON DR",
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"EnumerationDate": "08/01/2016",
"LastUpdateDate": "08/01/2016",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "NELSON",
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"LicenseNumber": "2901011845",
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}