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General NPI Number Information
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NPI Number | 1669227286
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Entity Type | Individual
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Provider Name | MRS. SIRILUK INCHANNARONG
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Gender | Female
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Dates
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Enumeration Date | 04/18/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 5414 FREDERICKSBURG RD STE 150
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3652
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Country | US
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Telephone | 210-615-9800
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Fax | 210-615-9801
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Provider Business Mailing Address
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Address Line | 202 ROARING CREEK DR
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City | BOERNE
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State | TX
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Zip | 78006-3919
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Country | US
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Telephone | 210-774-8125
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1157735
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License Number State | TX
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