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General NPI Number Information
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NPI Number | 1669027652
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Entity Type | Organization
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Legal Business Name | VENESALUD PRIMARY CARE, LLC
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Dates
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Enumeration Date | 08/06/2019
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 611 S CARLIN SPRINGS RD STE 412
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City | ARLINGTON
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State | VA
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Zip | 22204-1087
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Country | US
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Telephone | 703-344-2004
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Fax |
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Provider Business Mailing Address
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Address Line | 5504 SANDY FOLLY CT
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-1032
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Country | US
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Telephone | 757-771-5444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. GLENDA W THOMAS
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Credential | DNP, FNP-C
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Telephone | 703-344-2004
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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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