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General NPI Number Information
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NPI Number | 1225927304
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Entity Type | Organization
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Legal Business Name | PREMIUM PETAL LLC
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 13663 VAN DOREN RD
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City | MANASSAS
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State | VA
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Zip | 20112-3804
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Country | US
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Telephone | 804-501-9127
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Fax |
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Provider Business Mailing Address
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Address Line | 13663 VAN DOREN RD
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City | MANASSAS
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State | VA
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Zip | 20112-3804
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Country | US
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Telephone | 804-501-9127
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KHADIJAH MARSHALL
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Credential |
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Telephone | 804-501-9127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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