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General NPI Number Information
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NPI Number | 1609655927
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Entity Type | Individual
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Provider Name | ANDREA GAYLE SIMONS FNP
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Gender | Female
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 630 E 1400 N STE 150
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City | LOGAN
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State | UT
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Zip | 84341-2549
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Country | US
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Telephone | 435-915-4465
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Fax |
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Provider Business Mailing Address
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Address Line | 463 S CENTER ST
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City | HYRUM
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State | UT
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Zip | 84319-1606
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Country | US
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Telephone | 435-764-5289
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5680277-4405
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License Number State | UT
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