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General NPI Number Information
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NPI Number | 1538681788
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Entity Type | Individual
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Provider Name | MS. ANDREA PAULETTE REDIC
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Gender | Female
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 07/10/2017
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Provider Practice Location Address
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Address Line | 2141 N COLLINS ST STE 503
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City | ARLINGTON
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State | TX
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Zip | 76011-2812
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Country | US
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Telephone | 214-994-6899
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Fax | 817-303-1377
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Provider Business Mailing Address
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Address Line | 609 HOGAN ALLEY DR
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City | MANSFIELD
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State | TX
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Zip | 76063-5474
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Country | US
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Telephone | 214-994-6899
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Fax | 817-303-1377
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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