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General NPI Number Information
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NPI Number | 1194194381
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Entity Type | Individual
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Provider Name | MOLLY ANN DEFAZIO L.AC.
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Gender | Female
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 819 HARVEY RD NE
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City | AUBURN
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State | WA
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Zip | 98002-4225
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Country | US
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Telephone | 425-780-7502
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Fax | 888-975-7980
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Provider Business Mailing Address
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Address Line | 819 HARVEY RD NE
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City | AUBURN
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State | WA
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Zip | 98002-4225
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Country | US
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Telephone | 425-736-1995
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00000674
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 674
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License Number State | WA
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