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General NPI Number Information
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NPI Number | 1104671056
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Entity Type | Individual
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Provider Name | JACOB LEON-JIRO SECHREST DNP
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Gender | Male
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 3205 N ACADEMY BLVD STE 130
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-5152
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Country | US
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Telephone | 719-632-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 1363 HAWTHORN DR
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City | HANOVER
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State | MD
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Zip | 21076-2198
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Country | US
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Telephone | 443-691-0843
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | C-APN.0102233-C-NP
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License Number State | CO
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