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General NPI Number Information
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NPI Number | 1710427992
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Entity Type | Individual
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Provider Name | AMANDA REYNOLDS
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Gender | Female
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 520 9TH ST
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City | SLIDELL
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State | LA
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Zip | 70458-1416
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Country | US
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Telephone | 985-960-3759
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Fax |
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Provider Business Mailing Address
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Address Line | 520 NINTH STREET
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City | SLIDELL
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State | LA
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Zip | 70458
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Country | US
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Telephone | 985-960-3759
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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 | 2865X1600X
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Taxonomy Name | Operational (Transportable) Military General Acute Care Hospital
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License Number |
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License Number State |
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