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General NPI Number Information
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NPI Number | 1114456795
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Entity Type | Individual
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Provider Name | ANA D FORMAN FNP
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Gender | Female
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 1530 FRONT ST
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City | EAST MEADOW
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State | NY
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Zip | 11554-2265
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Country | US
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Telephone | 516-324-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 3268 45TH ST APT 1R
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City | ASTORIA
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State | NY
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Zip | 11103-1913
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Country | US
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Telephone | 917-732-6041
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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 | F340507-1
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License Number State | NY
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