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General NPI Number Information
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NPI Number | 1558531905
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Entity Type | Organization
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Legal Business Name | AVALON MEDICAL GROUP
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Dates
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Enumeration Date | 03/01/2008
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Last Update Date | 07/06/2012
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Provider Practice Location Address
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Address Line | 1900 SUMMIT BLVD
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City | PENSACOLA
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State | FL
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Zip | 32503-3359
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Country | US
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Telephone | 850-436-5900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10209
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City | PENSACOLA
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State | FL
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Zip | 32524-0209
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Country | US
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Telephone | 850-476-4200
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Fax | 866-684-0566
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | MS. KATHERINE K STANLEY
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Credential | ARNP-BC
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Telephone | 850-485-7341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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