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General NPI Number Information
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NPI Number | 1124932991
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Entity Type | Individual
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Provider Name | JACOB HENDRICKSON PARAMEDIC
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Gender | Male
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 123 S STATE ST
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City | BELVIDERE
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State | IL
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Zip | 61008-3628
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Country | US
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Telephone | 815-520-8687
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Fax |
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Provider Business Mailing Address
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Address Line | 403 BREE DR
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City | POPLAR GROVE
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State | IL
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Zip | 61065-8307
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Country | US
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Telephone | 815-520-8687
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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 | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 060629847
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License Number State | IL
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