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General NPI Number Information
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NPI Number | 1306235429
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Entity Type | Individual
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Provider Name | AMANDA RENEE WELLS GALLUPPI PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 317 WESTERN BLVD
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6338
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Country | US
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Telephone | 252-378-1968
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Fax |
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Provider Business Mailing Address
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Address Line | 404 HEADWATERS DR
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City | HAMPSTEAD
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State | NC
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Zip | 28443-2187
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-05490
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License Number State | NC
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