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General NPI Number Information
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NPI Number | 1558960179
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Entity Type | Individual
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Provider Name | OMOLOLA BEAIRD
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Gender | Female
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Dates
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Enumeration Date | 10/24/2020
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 41800 W 11 MILE RD STE 109
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City | NOVI
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State | MI
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Zip | 48375-1818
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Country | US
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Telephone | 248-660-1220
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746720
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City | ATLANTA
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State | GA
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Zip | 30374-6720
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Country | US
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Telephone | 312-733-9730
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 28207413A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704298788
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License Number State | MI
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