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General NPI Number Information
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NPI Number | 1629110655
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Entity Type | Individual
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Provider Name | STACY ANN VENCILL PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 4870 BARRANCA PKWY 350
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City | IRVINE
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State | CA
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Zip | 92604-4709
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Country | US
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Telephone | 949-451-6060
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Fax | 949-451-6070
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Provider Business Mailing Address
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Address Line | PO BOX 15243
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City | NEWPORT BEACH
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State | CA
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Zip | 92659-5243
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Country | US
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Telephone | 949-574-4600
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Fax | 949-574-4680
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA18107
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License Number State | CA
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