{
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"FirstLineMailingAddress": "5435 EMERSON WAY STE 110",
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"MailingAddressCityName": "INDIANAPOLIS",
"MailingAddressStateName": "IN",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "317-362-0293",
"MailingAddressFaxNumber": "317-672-4145",
"FirstLinePracticeLocationAddress": "5435 EMERSON WAY STE 110",
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"PracticeLocationAddressCityName": "INDIANAPOLIS",
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"PracticeLocationAddressTelephoneNumber": "317-362-0293",
"PracticeLocationAddressFaxNumber": "317-672-4145",
"EnumerationDate": "09/16/2020",
"LastUpdateDate": "10/20/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TOWNSEND",
"AuthorizedOfficialFirstName": "TAQUITA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER PROVIDER",
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"AuthorizedOfficialCredential": "NP",
"AuthorizedOfficialTelephoneNumber": "317-362-0293",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QU0200X",
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"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}