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General NPI Number Information
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NPI Number | 1306341201
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Entity Type | Individual
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Provider Name | JORDAN VANDEN HEUVEL
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Gender | Female
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Dates
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Enumeration Date | 03/24/2018
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 51 W FERNAU AVE
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City | OSHKOSH
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State | WI
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Zip | 54901-1217
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Country | US
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Telephone | 800-480-2474
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Fax | 920-748-1267
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Provider Business Mailing Address
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Address Line | W5721 JOCHMANN DR
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City | APPLETON
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State | WI
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Zip | 54915-5232
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Country | US
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Telephone | 920-410-7019
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 18031
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License Number State | WI
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