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General NPI Number Information
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NPI Number | 1447803416
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Entity Type | Organization
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Legal Business Name | RESOLUTE HEALTHCARE
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 07/21/2019
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Provider Practice Location Address
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Address Line | 4347 W GAY RD
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City | DIBERVILLE
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State | MS
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Zip | 39540-3412
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Country | US
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Telephone | 228-229-7989
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6940
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City | DIBERVILLE
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State | MS
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Zip | 39540-6901
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Country | US
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Telephone | 228-243-7711
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | MRS. JILLIAN M LADNER
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Credential | NP
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Telephone | 228-229-7989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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