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General NPI Number Information
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NPI Number | 1689108839
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Entity Type | Individual
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Provider Name | TODD AARON MACDONALD CRNA
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Gender | Male
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Dates
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Enumeration Date | 04/14/2017
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 2119 HIGHLANDER DR
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City | JOPLIN
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State | MO
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Zip | 64804-7005
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Country | US
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Telephone | 417-988-5969
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Fax |
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Provider Business Mailing Address
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Address Line | 2119 HIGHLANDER DR
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City | JOPLIN
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State | MO
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Zip | 64804-7005
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Country | US
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Telephone | 417-988-5969
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 2017009929
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209029242
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License Number State | IL
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