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General NPI Number Information
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NPI Number | 1245915925
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Entity Type | Individual
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Provider Name | MORGAN MICHAELA MACK
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Gender | Female
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 916 4TH AVE SW
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City | PIPESTONE
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State | MN
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Zip | 56164-1890
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Country | US
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Telephone | 507-825-5811
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Fax |
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Provider Business Mailing Address
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Address Line | 7900 E ARROWHEAD PKWY APT 328
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City | SIOUX FALLS
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State | SD
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Zip | 57110-7021
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 15324
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License Number State | MN
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