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General NPI Number Information
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NPI Number | 1629874474
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Entity Type | Individual
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Provider Name | PAUL ELLIOTT PMHNP-C
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Gender | Male
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 645 S ROGERS ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2353
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Country | US
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Telephone | 800-344-8802
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Fax | 812-337-2259
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Provider Business Mailing Address
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Address Line | 654 S ROGERS ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 28256244A
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License Number State | IN
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