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General NPI Number Information
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NPI Number | 1174864722
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Entity Type | Organization
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Legal Business Name | DAYSTAR FAMILY MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 03/06/2013
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Provider Practice Location Address
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Address Line | 24603 LAKE PATH CIR
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City | KATY
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State | TX
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Zip | 77493-2716
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Country | US
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Telephone | 281-396-4120
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Fax |
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Provider Business Mailing Address
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Address Line | 24603 LAKE PATH CIR
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City | KATY
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State | TX
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Zip | 77493-2716
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Country | US
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Telephone | 281-396-4120
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITONER/OWNER
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Name | DR. ROSELINE OLUCHI OKORO
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Credential | DNP, FNP-C
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Telephone | 281-396-4120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | TX
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