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General NPI Number Information
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NPI Number | 1568845832
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Entity Type | Organization
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Legal Business Name | SOLE PROPRIETOR
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Dates
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Enumeration Date | 07/06/2015
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 510 LOCUST AVE
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City | WASHINGTON
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State | PA
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Zip | 15301-3331
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Country | US
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Telephone | 724-222-2289
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Fax |
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Provider Business Mailing Address
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Address Line | 510 LOCUST AVE
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City | WASHINGTON
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State | PA
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Zip | 15301-3331
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Country | US
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Telephone | 724-222-2289
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Fax |
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Authorized Official
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Title or Position | CERTIFIED NURSE PRACTITONER
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Name | MICHELLE ALIN TRAPUZZANO
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Credential | CRNP
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Telephone | 724-222-2289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | SP015047
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License Number State | PA
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