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General NPI Number Information
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NPI Number | 1720084585
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Entity Type | Individual
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Provider Name | ANGELA GALE GROVERMAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 05/28/2008
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Provider Practice Location Address
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Address Line | 12140 NEW YORK RANCH RD
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City | JACKSON
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State | CA
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Zip | 95642-9407
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Country | US
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Telephone | 209-257-2400
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Fax | 209-257-2403
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Provider Business Mailing Address
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Address Line | PO BOX 939
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City | ANGELS CAMP
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State | CA
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Zip | 95222-0939
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Country | US
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Telephone | 209-754-6262
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Fax | 866-205-8079
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA15037
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License Number State | CA
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