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General NPI Number Information
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NPI Number | 1609892900
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Entity Type | Individual
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Provider Name | MARNE J CARMICHAEL WALSH M.S.,PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 670 PONAHAWAI ST STE 224
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City | HILO
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State | HI
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Zip | 96720-7829
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Country | US
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Telephone | 808-300-1064
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Fax |
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Provider Business Mailing Address
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Address Line | 64-1035 MAMALAHOA HIGHWAY, SUITE J AND K
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City | KAMUELA
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State | HI
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Zip | 96743
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Country | US
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Telephone | 808-885-4503
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Fax | 808-885-4517
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 273
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License Number State | HI
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