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General NPI Number Information
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NPI Number | 1548663768
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Entity Type | Individual
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Provider Name | KILEY STAVNES
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Gender | Female
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 1551 PROFESSIONAL LN SUITE 200
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City | LONGMONT
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State | CO
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Zip | 80501-6972
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Country | US
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Telephone | 303-772-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 4905 HAHNS PEAK DR UNIT 204
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City | LOVELAND
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State | CO
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Zip | 80538-6008
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0001258
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License Number State | CO
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