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General NPI Number Information
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NPI Number | 1285873893
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Entity Type | Individual
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Provider Name | CARRIE WISEN
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Gender | Female
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Dates
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Enumeration Date | 02/05/2009
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 815 N EL CENTRO AVE
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City | LOS ANGELES
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State | CA
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Zip | 90038-3805
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Country | US
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Telephone | 800-864-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 6637 FRANKLIN AVE APT. 10
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City | LOS ANGELES
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State | CA
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Zip | 90028-4760
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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