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General NPI Number Information
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NPI Number | 1538940374
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Entity Type | Individual
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Provider Name | HALEY G ROY FNP
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Gender | Female
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 1615 CREEKSIDE DR
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City | FOLSOM
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State | CA
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Zip | 95630-3491
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Country | US
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Telephone | 916-817-4132
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Fax |
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Provider Business Mailing Address
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Address Line | 1659 SUNNINGDALE DR
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City | ROSEVILLE
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State | CA
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Zip | 95747-5821
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Country | US
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Telephone | 916-719-2420
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | NP95027086
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License Number State | CA
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