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General NPI Number Information
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NPI Number | 1306957394
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Entity Type | Individual
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Provider Name | LOU ANN M. MCSTAY M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 715 HARMONY ST 2ND FLOOR
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-3147
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Country | US
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Telephone | 712-328-8500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 642117
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City | OMAHA
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State | NE
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Zip | 68164-8117
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20500
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License Number State | NE
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