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General NPI Number Information
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NPI Number | 1376345488
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Entity Type | Individual
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Provider Name | AMANDA BOONE PA
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Gender | Female
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 2740 SOUTH AVE W
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City | MISSOULA
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State | MT
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Zip | 59804-5135
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Country | US
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Telephone | 406-728-6101
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Fax |
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Provider Business Mailing Address
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Address Line | 6692 BRISTLE CONE CT
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City | LOLO
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State | MT
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Zip | 59847-9218
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 146541
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License Number State | MT
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