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General NPI Number Information
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NPI Number | 1487315420
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Entity Type | Individual
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Provider Name | HAILEY WILLOUGHBY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 1210 10TH AVE
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City | PORT HURON
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State | MI
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Zip | 48060-3406
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Country | US
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Telephone | 810-662-3505
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Fax |
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Provider Business Mailing Address
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Address Line | 812 LAPEER AVE STE B
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City | PORT HURON
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State | MI
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Zip | 48060-4480
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Country | US
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Telephone | 810-650-0644
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704278139
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License Number State | MI
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