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General NPI Number Information
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NPI Number | 1245866045
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Entity Type | Organization
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Legal Business Name | RESTOREDHEALTH LLC
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 4 JOHN CALVIN DR
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City | BLAUVELT
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State | NY
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Zip | 10913-1001
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Country | US
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Telephone | 772-834-2444
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 47
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City | BLAUVELT
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State | NY
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Zip | 10913-0047
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Country | US
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Telephone | 772-834-2444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLIE LEVEILLE
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Credential | NP
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Telephone | 772-834-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number |
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License Number State |
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