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General NPI Number Information
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NPI Number | 1679171326
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Entity Type | Individual
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Provider Name | MRS. CONSTANCE PIERRE LOUIS GAUTHIER
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Gender | Female
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Dates
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Enumeration Date | 10/14/2020
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 812 DOGWOOD RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6141
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Country | US
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Telephone | 561-932-7605
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Fax |
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Provider Business Mailing Address
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Address Line | 9796 STOVER WAY
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City | WELLINGTON
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State | FL
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Zip | 33414-6492
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Country | US
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Telephone | 156-193-2760
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | FL
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