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General NPI Number Information
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NPI Number | 1033998166
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Entity Type | Individual
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Provider Name | MADISON NICOLE BESTLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 480 OSBORNE RD NE
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City | FRIDLEY
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State | MN
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Zip | 55432-2773
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Country | US
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Telephone | 763-581-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 402 2ND ST NE APT 411
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City | MINNEAPOLIS
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State | MN
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Zip | 55413-2097
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Country | US
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Telephone | 651-285-9639
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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 | 14570
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License Number State | MN
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