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General NPI Number Information
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NPI Number | 1700511995
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Entity Type | Individual
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Provider Name | BLAIR M VIVIRITO
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Gender | Female
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 460 NEW YORK AVE NW UNIT 904
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City | WASHINGTON
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State | DC
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Zip | 20001-5319
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Country | US
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Telephone | 702-526-8599
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 2 BOX 9464
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City | APO
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State | AE
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Zip | 09012-0095
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Country | US
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Telephone |
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 11020457
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License Number State | FL
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