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General NPI Number Information
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NPI Number | 1700687969
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Entity Type | Individual
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Provider Name | MALLORY AVIVA FELDMANN MSN, CRNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 15245 SHADY GROVE RD STE 150
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City | ROCKVILLE
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State | MD
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Zip | 20850-7210
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Country | US
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Telephone | 301-869-9776
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Fax |
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Provider Business Mailing Address
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Address Line | 9700 OAKDALE DR APT 408
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City | ROCKVILLE
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State | MD
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Zip | 20850-4614
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Country | US
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Telephone | 240-205-6180
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R249802
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License Number State | MD
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