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General NPI Number Information
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NPI Number | 1508641143
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Entity Type | Individual
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Provider Name | KRISTEN CALLANAN KOZIOL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 275 VARNUM AVE STE 201
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City | LOWELL
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State | MA
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Zip | 01854-2141
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Country | US
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Telephone | 978-452-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 8 WILLOWDALE RD
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City | TYNGSBORO
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State | MA
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Zip | 01879-2109
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Country | US
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Telephone |
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN2309840
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 00000000000000
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License Number State | MA
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