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General NPI Number Information
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NPI Number | 1376545616
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Entity Type | Individual
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Provider Name | MARY VAN SICKLE M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 06/28/2017
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Provider Practice Location Address
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Address Line | 7777 SOUTHWEST FWY STE 616
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City | HOUSTON
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State | TX
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Zip | 77074-1802
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Country | US
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Telephone | 713-773-3983
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Fax | 713-271-4076
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Provider Business Mailing Address
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Address Line | PO BOX 6880
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City | SANTA FE
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State | NM
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Zip | 87502-6880
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Country | US
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Telephone | 505-395-2288
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Fax | 505-983-8135
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | H5211
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License Number State | TX
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