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General NPI Number Information
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NPI Number | 1043067713
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Entity Type | Individual
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Provider Name | DERRIK J HARADON-CHRISLER FNP
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Gender | Male
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Dates
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Enumeration Date | 05/01/2024
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 12053 OAKFIELD CIR
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City | BIG FLATS
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State | NY
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Zip | 14814-9600
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Country | US
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Telephone | 607-368-1267
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Fax |
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Provider Business Mailing Address
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Address Line | 12053 OAKFIELD CIR
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City | BIG FLATS
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State | NY
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Zip | 14814-9600
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP033192
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 357372
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 819538
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN799382
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License Number State | PA
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