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General NPI Number Information
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NPI Number | 1538169792
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Entity Type | Individual
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Provider Name | TIM B OSULLIVAN NP
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 4444 GREGORY DR
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City | MAUMEE
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State | OH
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Zip | 43537-1822
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Country | US
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Telephone | 419-893-7606
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Fax |
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Provider Business Mailing Address
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Address Line | 4444 GREGORY DR
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City | MAUMEE
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State | OH
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Zip | 43537-1822
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Country | US
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Telephone | 419-893-7906
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 154376
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN154376
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License Number State | OH
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