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General NPI Number Information
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NPI Number | 1003154899
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Entity Type | Individual
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Provider Name | MICHAEL JOHN MEANS CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/29/2013
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-4472
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Country | US
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Telephone | 253-968-2235
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 621
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City | PORT ORCHARD
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State | WA
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Zip | 98366-0621
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Country | US
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Telephone | 360-362-2035
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP60333553
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License Number State | WA
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