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General NPI Number Information
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NPI Number | 1093606378
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Entity Type | Organization
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Legal Business Name | RADIANT HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 508 7TH STREET OFFICE #111
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City | ALTAVISTA
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State | VA
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Zip | 24517
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Country | US
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Telephone | 434-404-4728
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 123
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City | FOREST
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State | VA
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Zip | 24551-0123
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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 | NURSE PRACTITIONER
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Name | GRACE MUMBI KAMAU
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Credential | WHNP
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Telephone | 434-404-4728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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