{
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"FirstLineMailingAddress": "16523 7TH PL W",
"SecondLineMailingAddress": null,
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"MailingAddressStateName": "WA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-412-3280",
"MailingAddressFaxNumber": "412-412-3281",
"FirstLinePracticeLocationAddress": "4300 TALBOT RD S",
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"EnumerationDate": "03/03/2010",
"LastUpdateDate": "03/03/2010",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BERGESON",
"AuthorizedOfficialFirstName": "CARRIE",
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"AuthorizedOfficialTelephoneNumber": "425-412-3280",
"Taxonomies": {
"Taxonomy": {
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}