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General NPI Number Information
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NPI Number | 1427232081
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Entity Type | Individual
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Provider Name | NATASHA C SIMMONS WYLLIE MD
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Gender | Female
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 22895 BRAMBLETON PLAZA SUITE 200
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City | BRAMBLETON
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State | VA
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Zip | 20148
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Country | US
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Telephone | 703-722-2312
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Fax | 703-722-2317
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Provider Business Mailing Address
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Address Line | 12011 LEE JACKSON MEMORIAL HIGHWAY #504
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City | FAIRFAX
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State | VA
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Zip | 22033
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Country | US
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Telephone | 703-391-2030
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Fax | 703-273-3943
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M8344
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101248112
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License Number State | VA
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