{
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  "enumeration_type": "NPI-1",
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      "address_1": "6040 EARLE BROWN DR STE 310B",
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      "city": "BROOKLYN CENTER",
      "country_code": "US",
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      "address_1": "10717 AUSTIN ST NE APT 342",
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      "city": "BLAINE",
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      "country_name": "United States",
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    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": []
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}