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General NPI Number Information
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NPI Number | 1689427239
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Entity Type | Organization
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Legal Business Name | SAGUARO BLOOM MED SPA LLC
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Dates
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Enumeration Date | 04/11/2024
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 15323 N SCOTTSDALE ROAD SUITE 180, ROOM 12
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City | SCOTTSDALE
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State | AZ
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Zip | 85254
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Country | US
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Telephone | 315-707-5676
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Fax |
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Provider Business Mailing Address
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Address Line | 5243 E THUNDER HAWK RD
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City | CAVE CREEK
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State | AZ
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Zip | 85331-5593
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Country | US
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Telephone | 314-707-5676
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Fax |
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Authorized Official
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Title or Position | OWNER, NURSE PRACTITIONER
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Name | KATIE MEAHAN
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Credential | AGACNP-BC
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Telephone | 314-707-5676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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