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General NPI Number Information
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NPI Number | 1316691504
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Entity Type | Individual
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Provider Name | VICTORIA C BRANCH
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Gender | Female
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Dates
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Enumeration Date | 02/07/2022
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 14660 GRAND FOREST TER
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City | SOUTH CHESTERFIELD
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State | VA
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Zip | 23834-6827
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Country | US
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Telephone | 804-892-7650
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Fax |
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Provider Business Mailing Address
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Address Line | 14660 GRAND FOREST TER
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City | SOUTH CHESTERFIELD
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State | VA
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Zip | 23834-6827
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Country | US
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Telephone | 804-835-4808
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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 | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number | T65496945
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License Number State | VA
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