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General NPI Number Information
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NPI Number | 1689493991
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Entity Type | Individual
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Provider Name | ASHLEIGH BERGQUIST CPNP-AC
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Gender | Female
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 17600 INTERSTATE 45 S
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City | THE WOODLANDS
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State | TX
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Zip | 77384-5148
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Country | US
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Telephone | 936-267-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 2832 BEECH RIVER CT
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City | CONROE
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State | TX
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Zip | 77301-2388
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Country | US
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Telephone | 936-525-7440
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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 | 1170319
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License Number State | TX
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