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General NPI Number Information
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NPI Number | 1154929909
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Entity Type | Organization
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Legal Business Name | WATER CITY CARE MISSION, INC.
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Dates
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Enumeration Date | 10/14/2020
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 449 HIGH AVE.
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City | OSHKOSH
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State | WI
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Zip | 54901-4708
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Country | US
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Telephone | 920-234-6970
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Fax | 920-744-2488
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Provider Business Mailing Address
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Address Line | 449 HIGH AVE.
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City | OSHKOSH
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State | WI
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Zip | 54901-4708
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Country | US
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Telephone | 920-234-6970
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Fax | 920-744-2488
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BRIANNA M. KLOTZ
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Credential | APNP
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Telephone | 920-234-6970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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