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General NPI Number Information
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NPI Number | 1306565189
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Entity Type | Individual
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Provider Name | KATIE ANN STAFFORD FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 830 S OTSEGO AVE
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City | GAYLORD
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State | MI
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Zip | 49735-1776
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Country | US
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Telephone | 888-247-5701
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Fax |
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Provider Business Mailing Address
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Address Line | 4381 GEHRKE RD
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City | OSSINEKE
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State | MI
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Zip | 49766-8712
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Country | US
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Telephone | 989-884-4266
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704283258
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License Number State | MI
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