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General NPI Number Information
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NPI Number | 1730651233
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Entity Type | Individual
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Provider Name | KATHERINE WILSON CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 705 BANK ST NE
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City | DECATUR
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State | AL
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Zip | 35601-1609
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Country | US
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Telephone | 256-274-4523
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Fax |
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Provider Business Mailing Address
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Address Line | 2704 BRANSFORD TRL SE
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City | OWENS CROSS ROADS
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State | AL
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Zip | 35763-8456
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Country | US
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Telephone | 256-529-9600
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1-130871
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License Number State | AL
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