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General NPI Number Information
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NPI Number | 1386821072
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Entity Type | Organization
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Legal Business Name | FULLY CONFIDENT RESTWEAR INC.
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 09/05/2008
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Provider Practice Location Address
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Address Line | 603 J CLYDE MORRIS BLVD SUITE #4
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1826
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Country | US
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Telephone | 757-595-3488
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Fax |
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Provider Business Mailing Address
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Address Line | 4417 BRENT ST
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City | SUFFOLK
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State | VA
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Zip | 23435-2528
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Country | US
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Telephone | 757-686-8338
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Fax |
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Authorized Official
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Title or Position | OWNER/ FITTER
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Name | MRS. SHERREE JOYCE WILSON
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Credential | CEO/CFM
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Telephone | 757-595-3488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 8863142008
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License Number State | VA
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