{
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"IsOrgSubpart": "Y",
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"FirstLineMailingAddress": "105 MILLS AVENUE SUITE 300",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87701",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-425-9311",
"MailingAddressFaxNumber": "505-425-9047",
"FirstLinePracticeLocationAddress": "105 MILLS AVE STE 300",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAS VEGAS",
"PracticeLocationAddressStateName": "NM",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-425-9311",
"PracticeLocationAddressFaxNumber": "505-425-9047",
"EnumerationDate": "11/18/2013",
"LastUpdateDate": "11/18/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELLIOTT",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": "H",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "505-425-9311",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "CNP00739",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}