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General NPI Number Information
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NPI Number | 1467555680
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Entity Type | Individual
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Provider Name | DIANE SMOGOR M.N.T.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8051 S EMERSON AVE SUITE 340
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-8600
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Country | US
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Telephone | 317-865-5904
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Fax | 317-865-5321
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Provider Business Mailing Address
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Address Line | PO BOX 66664048
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City | INDIANAPOLIS
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State | IN
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Zip | 46266-4048
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Country | US
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Telephone | 317-780-3333
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Fax | 317-780-3345
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 37001004A
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License Number State | IN
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