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General NPI Number Information
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NPI Number | 1295231918
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Entity Type | Individual
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Provider Name | JENNIFER DIANE O'NEAL RN
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Gender | Female
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 1540 TRINITY PL
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City | MISHAWAKA
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State | IN
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Zip | 46545-5006
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Country | US
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Telephone | 574-272-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 5203 W CONCORD DR
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City | LA PORTE
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State | IN
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Zip | 46350-7314
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Country | US
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Telephone | 219-344-7697
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28175456A
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License Number State | IN
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