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General NPI Number Information
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NPI Number | 1427282706
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Entity Type | Individual
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Provider Name | MICHAEL D. KACSMAR CRNP
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Gender | Male
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 529 SUNFLOWER DR
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City | DU BOIS
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State | PA
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Zip | 15801-2378
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Country | US
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Telephone | 814-371-1510
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Fax | 814-371-2922
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Provider Business Mailing Address
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Address Line | 300 E MAIN ST PO BOX 189
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City | REYNOLDSVILLE
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State | PA
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Zip | 15851-1282
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Country | US
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Telephone | 814-371-1510
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Fax | 814-371-2922
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP010286
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License Number State | PA
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