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General NPI Number Information
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NPI Number | 1366014664
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Entity Type | Individual
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Provider Name | COLLEEN PUCCINI APRN
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Gender | Female
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 10400 W HIGGINS RD STE 100
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City | ROSEMONT
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State | IL
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Zip | 60018-3703
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Country | US
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Telephone | 847-416-2625
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Fax |
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Provider Business Mailing Address
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Address Line | 1365 SPAULDING RD
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City | BARTLETT
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State | IL
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Zip | 60103-1205
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Country | US
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Telephone | 630-456-8598
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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 | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 209.023490
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License Number State | IL
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