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General NPI Number Information
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NPI Number | 1114271400
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Entity Type | Organization
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Legal Business Name | SERENITY IOP LLC
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 18 CLINIC DR
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City | PARIS
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State | KY
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Zip | 40361-2161
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Country | US
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Telephone | 859-585-0015
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Fax |
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Provider Business Mailing Address
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Address Line | 18 CLINIC DR
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City | PARIS
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State | KY
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Zip | 40361-2161
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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 | OWNER
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Name | NITA HALE
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Credential | BSN
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Telephone | 859-588-0015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 1075442
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License Number State | KY
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