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General NPI Number Information
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NPI Number | 1295617769
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Entity Type | Individual
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Provider Name | DANIELLE K TRUDEAU PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 8 ABBOTT PARK PL
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City | PROVIDENCE
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State | RI
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Zip | 02903-3703
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Country | US
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Telephone | 401-598-4558
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Fax |
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Provider Business Mailing Address
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Address Line | 258 OHIO AVE
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-2123
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Country | US
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Telephone | 413-726-4951
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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 |
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License Number State |
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