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General NPI Number Information
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NPI Number | 1467011056
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Entity Type | Individual
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Provider Name | TRACI POE MA, MCCLC
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Gender | Female
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 06/07/2019
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Provider Practice Location Address
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Address Line | 1716 GRIFFIN LN
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City | MANSFIELD
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State | TX
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Zip | 76063-8560
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Country | US
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Telephone | 817-965-5886
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Fax | 866-929-1927
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Provider Business Mailing Address
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Address Line | 6 KEVIN CT
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City | MANSFIELD
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State | TX
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Zip | 76063-4861
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Country | US
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Telephone | 682-472-7807
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Fax | 866-929-1927
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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