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General NPI Number Information
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NPI Number | 1205281565
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Entity Type | Individual
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Provider Name | JODY ANN MCMAHON
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Gender | Female
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Dates
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Enumeration Date | 04/24/2016
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Last Update Date | 04/24/2016
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Provider Practice Location Address
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Address Line | 22250 PROVIDENCE DR
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4825
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Country | US
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Telephone | 248-849-3939
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Fax |
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Provider Business Mailing Address
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Address Line | 14850 QUORUM DR 120
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City | DALLAS
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State | TX
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Zip | 75254-7566
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Country | US
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Telephone | 844-325-7722
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Fax | 214-242-8063
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704263050
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License Number State | MI
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