{
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"FirstLineMailingAddress": "7 HAYES LN",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "19 MUZZEY ST # L20",
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"PracticeLocationAddressCityName": "LEXINGTON",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/11/2020",
"LastUpdateDate": "02/11/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IVANENKO",
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"AuthorizedOfficialCredential": "OTR/L",
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"TaxonomyName": "Clinic/Center",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}