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General NPI Number Information
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NPI Number | 1457006660
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Entity Type | Organization
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Legal Business Name | ELIVATE WELLNESS LLC
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 1707 CEDAR GROVE RD
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City | SHEPHERDSVILLE
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State | KY
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Zip | 40165-8572
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Country | US
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Telephone | 502-338-2561
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 MOUNT CARMEL CHURCH RD
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City | LEBANON JUNCTION
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State | KY
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Zip | 40150-8269
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Country | US
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Telephone | 502-338-2561
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. OLIVIA STIVERS
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Credential | MSN, APRN
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Telephone | 502-338-2561
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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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