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General NPI Number Information
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NPI Number | 1447876511
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Entity Type | Individual
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Provider Name | MORGAN OLIVIA GUSTIN MSPA, PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 2217 PARK BEND DR STE 300
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City | AUSTIN
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State | TX
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Zip | 78758-5674
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Country | US
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Telephone | 512-382-1933
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Fax |
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Provider Business Mailing Address
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Address Line | 13225 ROADSTER DR
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City | FRISCO
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State | TX
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Zip | 75033-1660
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Country | US
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Telephone | 469-815-3511
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA13705
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License Number State | TX
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