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General NPI Number Information
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NPI Number | 1043859267
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Entity Type | Individual
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Provider Name | RILEY LYNN WILLMAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 13860 N NORTHSIGHT BLVD
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-3654
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Country | US
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Telephone | 602-734-0252
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Fax |
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Provider Business Mailing Address
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Address Line | 20050 N CAVE CREEK RD APT 386
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City | PHOENIX
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State | AZ
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Zip | 85024-5436
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Country | US
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Telephone | 248-462-1456
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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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