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General NPI Number Information
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NPI Number | 1578223921
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Entity Type | Individual
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Provider Name | NICOLE MARIE WHITTEN APRN
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Gender | Female
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 17901 GOVERNORS HWY STE 209
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City | HOMEWOOD
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State | IL
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Zip | 60430-1144
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Country | US
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Telephone | 708-960-4280
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Fax |
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Provider Business Mailing Address
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Address Line | 430 E 162ND ST # 487
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2258
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.023704
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License Number State | IL
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