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General NPI Number Information
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NPI Number | 1619898442
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Entity Type | Organization
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Legal Business Name | ERASE HAUS ADVANCED PRACTICE NURSING CORPORATION
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Dates
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Enumeration Date | 07/25/2026
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Last Update Date | 07/25/2026
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Provider Practice Location Address
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Address Line | 1601 MCHENRY VILLAGE WAY STE 5
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City | MODESTO
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State | CA
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Zip | 95350-4338
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Country | US
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Telephone | 209-620-3216
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 MCHENRY VILLAGE WAY STE 5
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City | MODESTO
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State | CA
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Zip | 95350-4338
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Country | US
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Telephone | 209-620-3216
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIRSTIN BRAY
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Credential | FNP-C
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Telephone | 209-481-8634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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