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General NPI Number Information
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NPI Number | 1649216375
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Entity Type | Individual
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Provider Name | MARILEE KURACINA MD
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Gender | Female
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 895 N 6TH E ST LUKE'S ELMORE
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-2207
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Country | US
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Telephone | 208-580-2683
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1004
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City | NAMPA
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State | ID
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Zip | 83653-1004
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Country | US
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Telephone | 208-546-2491
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M5035
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License Number State | ID
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