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General NPI Number Information
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NPI Number | 1699552224
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Entity Type | Organization
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Legal Business Name | ROOTED FAMILY WELLNESS LLC
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 2 SOUTHSIDE RD
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City | YORK
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State | ME
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Zip | 03909-5117
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Country | US
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Telephone | 603-759-6601
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Fax |
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Provider Business Mailing Address
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Address Line | 105 GUYS WAY
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City | ELIOT
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State | ME
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Zip | 03903-1266
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Country | US
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Telephone | 603-759-6601
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ASHLEY E MACE
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Credential | NP
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Telephone | 603-759-6601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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