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General NPI Number Information
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NPI Number | 1477276871
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Entity Type | Individual
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Provider Name | CASSANDRA GAGLIARDO PMHNP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 3333 EVERGREEN DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9493
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Country | US
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Telephone | 616-600-2845
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Fax | 616-327-6368
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Provider Business Mailing Address
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Address Line | 3333 EVERGREEN DR NE STE 210
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9830
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Country | US
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Telephone | 616-600-2845
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Fax | 616-327-6368
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704261303
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License Number State | MI
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