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General NPI Number Information
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NPI Number | 1700578895
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Entity Type | Individual
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Provider Name | KELLY TRAURIG LM, CPM
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Gender | Female
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 2112 CARAWAY ST
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City | ESCONDIDO
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State | CA
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Zip | 92026-1134
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Country | US
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Telephone | 760-560-7582
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Fax | 442-888-1829
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Provider Business Mailing Address
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Address Line | 2112 CARAWAY ST
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City | ESCONDIDO
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State | CA
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Zip | 92026-1134
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Country | US
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Telephone | 760-560-7582
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | LM709
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License Number State | CA
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