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General NPI Number Information
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NPI Number | 1053096842
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Entity Type | Individual
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Provider Name | TAYLOR BOAGNI PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 10/13/2024
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Provider Practice Location Address
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Address Line | 3720 WESTHEIMER RD STE 650
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City | HOUSTON
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State | TX
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Zip | 77027-5277
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Country | US
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Telephone | 713-301-3551
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Fax |
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Provider Business Mailing Address
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Address Line | 106 TOWNE RD
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City | LAFAYETTE
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State | LA
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Zip | 70508-6437
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Country | US
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Telephone | 337-351-7693
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA17271
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License Number State | TX
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