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General NPI Number Information
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NPI Number | 1518571462
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Entity Type | Individual
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Provider Name | JESSICA ANNAHEIM
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Gender | Female
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 5562 PHILADELPHIA ST STE 200
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City | CHINO
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State | CA
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Zip | 91710-2482
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Country | US
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Telephone | 909-464-9119
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Fax |
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Provider Business Mailing Address
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Address Line | 5562 PHILADELPHIA ST STE 200
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City | CHINO
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State | CA
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Zip | 91710-2482
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Country | US
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Telephone | 909-464-9119
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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 | 95011600
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License Number State | CA
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