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General NPI Number Information
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NPI Number | 1326473950
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Entity Type | Individual
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Provider Name | MS. BREANNA JEAN CARLSON
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Gender | Female
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 7000 N MCCORMICK BLVD
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-2726
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Country | US
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Telephone | 888-325-0862
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Fax |
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Provider Business Mailing Address
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Address Line | 6301 N SHERIDAN RD APT 4V
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City | CHICAGO
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State | IL
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Zip | 60660-1728
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Country | US
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Telephone | 218-348-4595
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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