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General NPI Number Information
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NPI Number | 1083353361
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Entity Type | Individual
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Provider Name | ANA PARK
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Gender | Female
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Dates
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Enumeration Date | 06/03/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 10 MEDICAL PLZ STE 208
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City | GLEN COVE
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State | NY
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Zip | 11542-2101
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Country | US
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Telephone | 516-674-1647
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Fax |
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Provider Business Mailing Address
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Address Line | 54 CENTRAL PARK RD
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City | PLAINVIEW
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State | NY
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Zip | 11803-2012
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Country | US
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Telephone | 646-306-0081
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 686204
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License Number State | NY
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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 | 350166
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License Number State | NY
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