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General NPI Number Information
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NPI Number | 1306714118
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Entity Type | Organization
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Legal Business Name | BABY BLOSSOM PEDIATRCS
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Dates
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Enumeration Date | 10/24/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 2463 S M 30
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City | WEST BRANCH
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State | MI
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Zip | 48661-9312
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Country | US
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Telephone | 989-345-3660
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Fax |
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Provider Business Mailing Address
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Address Line | 2172 W NINE MILE RD # 230
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City | PENSACOLA
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State | FL
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Zip | 32534-9413
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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 | OWNER/PEDIATRICIAN
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Name | DR. DANIELLE WALLACE
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Credential | MD
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Telephone | 616-585-9897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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