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General NPI Number Information
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NPI Number | 1750427902
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Entity Type | Individual
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Provider Name | MARY KATHLEEN MAGNUSEN CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 1915 E REZANOF DR
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City | KODIAK
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State | AK
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Zip | 99615
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Country | US
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Telephone | 907-486-9500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3706
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City | PORTLAND
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State | OR
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Zip | 97208-3706
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Country | US
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Telephone | 866-907-1068
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Fax | 425-917-9141
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | NURA325
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License Number State | AK
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