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General NPI Number Information
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NPI Number | 1023640034
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Entity Type | Individual
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Provider Name | FAITH KELLY DAMMANN SCHLICHT PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/07/2020
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 1406 6TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1901
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Country | US
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Telephone | 320-255-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 911 8TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-2911
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Country | US
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Telephone | 320-282-9315
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 13331
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License Number State | MN
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