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General NPI Number Information
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NPI Number | 1386388809
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Entity Type | Individual
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Provider Name | KELLY RAE VOGEL
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Gender | Female
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 100 NAVARRE PLACE SUITE 4470
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City | SOUTH BEND
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State | IN
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Zip | 46601
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Country | US
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Telephone | 574-647-1405
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Fax | 574-647-3970
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Provider Business Mailing Address
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Address Line | 1140 QUIGLEY PL
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City | SOUTH BEND
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State | IN
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Zip | 46617-4406
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Country | US
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Telephone | 519-067-8919
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | 28239544A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 71016343A
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License Number State | IN
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