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General NPI Number Information
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NPI Number | 1518515998
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Entity Type | Individual
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Provider Name | EVELYN MADISON
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Gender | Female
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Dates
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Enumeration Date | 08/29/2019
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 102 W BLUE RIDGE ST
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City | STUART
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State | VA
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Zip | 24171-1579
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Country | US
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Telephone | 276-694-4969
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Fax | 276-694-3124
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Provider Business Mailing Address
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Address Line | 1718 POPLAR DR
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City | STUART
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State | VA
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Zip | 24171-2817
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Country | US
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Telephone | 276-358-0950
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Fax | 276-694-3124
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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