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General NPI Number Information
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NPI Number | 1265169510
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Entity Type | Individual
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Provider Name | KATHRYN JO MCNALLY
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Gender | Female
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 1937 WASHINGTON ST APT 24
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City | DAVENPORT
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State | IA
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Zip | 52804-2162
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Country | US
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Telephone | 815-993-7072
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Fax |
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Provider Business Mailing Address
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Address Line | 5676 STATELINE RD
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City | SOUTH BELOIT
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State | IL
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Zip | 61080-9512
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Country | US
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Telephone | 815-993-7072
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7799-23
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License Number State | WI
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