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General NPI Number Information
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NPI Number | 1124857081
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Entity Type | Individual
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Provider Name | OBED RANDALL
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Gender | Male
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Dates
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Enumeration Date | 07/30/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 29787 JOHN J WILLIAMS HIGHWAY, UNIT #8
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City | MILLSBORO
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State | DE
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Zip | 19966-1996
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Country | US
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Telephone | 800-818-8680
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Fax | 866-229-0237
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Provider Business Mailing Address
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Address Line | 1340 MIDDLEFORD ROAD STE 401
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City | SEAFORD
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State | DE
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Zip | 19973-3665
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Country | US
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Telephone | 8-188-6808
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Fax | 866-229-0237
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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 | LG-0012801
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License Number State | DE
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