{
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"EIN": null,
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"Credential": null,
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"OtherLastName": "LUCKMAN-WILCOX",
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"OtherCredential": "PHYSICIAN ASSISTANT",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "571 SAINT JOSEPHS BLVD",
"SecondLineMailingAddress": "FL 2",
"MailingAddressCityName": "ELMIRA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "607-271-2050",
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"FirstLinePracticeLocationAddress": "2977 WESTINGHOUSE RD",
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"PracticeLocationAddressCityName": "HORSEHEADS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "607-873-1832",
"PracticeLocationAddressFaxNumber": "607-873-1833",
"EnumerationDate": "03/19/2012",
"LastUpdateDate": "08/16/2016",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physician Assistant",
"LicenseNumber": "015194-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}