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General NPI Number Information
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NPI Number | 1114426657
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Entity Type | Individual
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Provider Name | RAINYA JADE STRACK
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Gender | Female
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Dates
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Enumeration Date | 02/11/2018
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Last Update Date | 02/11/2018
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Provider Practice Location Address
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Address Line | 3700 W DIVISION ST STE 105
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City | SAINT CLOUD
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State | MN
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Zip | 56301-4031
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Country | US
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Telephone | 320-423-1652
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Fax |
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Provider Business Mailing Address
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Address Line | 509 5TH ST SW
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City | LITTLE FALLS
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State | MN
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Zip | 56345-1716
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Country | US
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Telephone | 320-423-1652
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 059237-2
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License Number State | MN
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