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General NPI Number Information
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NPI Number | 1124181151
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Entity Type | Individual
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Provider Name | BETH ANN ROSE NP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 550 UNIVERSITY BLVD UH 1115-A
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5149
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Country | US
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Telephone | 317-944-7490
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Fax | 317-944-5994
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Provider Business Mailing Address
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Address Line | 4957 OAKTON ST STE 237
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City | SKOKIE
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State | IL
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Zip | 60077-2903
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Country | US
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Telephone | 773-543-6479
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 28136599A
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License Number State | IN
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