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General NPI Number Information
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NPI Number | 1174037113
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Entity Type | Organization
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Legal Business Name | HEALTHY FUNCTION LLC
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 550 W SUNNYSIDE RD STE 7
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City | IDAHO FALLS
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State | ID
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Zip | 83402-4642
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Country | US
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Telephone | 208-521-3257
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Fax |
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Provider Business Mailing Address
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Address Line | 4270 FRONTIER DR
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City | AMMON
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State | ID
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Zip | 83406-4788
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Country | US
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Telephone | 208-521-3257
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELANIE HILL
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Credential | RDH, OMT
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Telephone | 208-521-3257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH-0982
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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