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General NPI Number Information
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NPI Number | 1013086685
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Entity Type | Organization
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Legal Business Name | DEVINE FAMILY HEALTHCARE
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 38 APACHE PLUME RD
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City | LOS LUNAS
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State | NM
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Zip | 87031-9545
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Country | US
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Telephone | 505-859-0686
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Fax | 505-565-2835
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Provider Business Mailing Address
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Address Line | PO BOX 907
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City | BELEN
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State | NM
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Zip | 87002-0907
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Country | US
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Telephone | 505-859-0686
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Fax | 505-565-2835
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARY J DEVINE
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Credential | CFNP
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Telephone | 505-859-0686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | R48132
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License Number State | NM
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