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General NPI Number Information
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NPI Number | 1629597893
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Entity Type | Individual
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Provider Name | ANJELENE REYNOLDS
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Gender | Female
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 2200 BRYANT WILLIAMS DR STE 1
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-1121
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Country | US
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Telephone | 541-884-7746
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 LATIGO DR
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City | HENDERSON
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State | NV
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Zip | 89002-3650
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Country | US
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Telephone | 406-381-9943
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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