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General NPI Number Information
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NPI Number | 1497940860
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Entity Type | Organization
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Legal Business Name | THE SAINT PAUL LUNG CLINIC
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 225 SMITH AVE N STE 300
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City | SAINT PAUL
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State | MN
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Zip | 55102-2592
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Country | US
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Telephone | 651-726-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 225 SMITH AVE N STE 300
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City | SAINT PAUL
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State | MN
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Zip | 55102-2592
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Country | US
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Telephone | 651-726-6200
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. TOM LORENTZEN
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Credential |
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Telephone | 651-726-6210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R-157185-5
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License Number State | MN
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