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General NPI Number Information
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NPI Number | 1205784147
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Entity Type | Individual
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Provider Name | WINTER LILY POOL
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Gender | Female
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Dates
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Enumeration Date | 03/17/2026
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 7609 WELLS FARGO TRL NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-2848
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Country | US
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Telephone | 505-803-9364
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Fax | 505-803-9364
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Provider Business Mailing Address
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Address Line | 10511 GOLF COURSE RD NW STE 103
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5917
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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