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General NPI Number Information
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NPI Number | 1295443828
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Entity Type | Organization
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Legal Business Name | DREAMWEAVER ANESTHESIA, LLC
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 132 S 1ST ST
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City | MOUNT HOREB
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State | WI
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Zip | 53572-1949
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Country | US
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Telephone | 608-341-7817
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Fax |
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Provider Business Mailing Address
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Address Line | 132 S 1ST ST
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City | MOUNT HOREB
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State | WI
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Zip | 53572-1949
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Country | US
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Telephone | 608-341-7817
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA EAGAN
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Credential | DNP
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Telephone | 336-558-1837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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