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General NPI Number Information
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NPI Number | 1689186124
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Entity Type | Individual
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Provider Name | JEANETTE ELLA POWERS
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Gender | Female
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Dates
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Enumeration Date | 10/24/2017
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | 5690 W ATLANTIC AVE APT 304
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City | DELRAY BEACH
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State | FL
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Zip | 33484-8218
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Country | US
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Telephone | 708-289-5341
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Fax |
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Provider Business Mailing Address
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Address Line | 5690 W ATLANTIC AVE APT 304
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City | DELRAY BEACH
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State | FL
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Zip | 33484-8218
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Country | US
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Telephone | 708-289-5341
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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 | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | W445166
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | W445166
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | W445166
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | W445166
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License Number State | FL
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