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General NPI Number Information
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NPI Number | 1073853396
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Entity Type | Individual
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Provider Name | JANELLE SIMONE MORRISSEY MSOTR/L
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Gender | Female
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Dates
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Enumeration Date | 02/23/2013
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Last Update Date | 02/23/2013
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Provider Practice Location Address
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Address Line | 2765 JEFFERSON DAVIS HWY SUITE 209
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City | STAFFORD
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State | VA
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Zip | 22554-8331
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Country | US
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Telephone | 540-720-2261
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Fax | 540-720-5660
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Provider Business Mailing Address
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Address Line | 13890 BRADDOCK RD SUITE 205
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City | CENTREVILLE
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State | VA
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Zip | 20121-2435
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Country | US
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Telephone | 540-720-2261
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Fax | 540-720-5660
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 0119004356
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License Number State | VA
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