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General NPI Number Information
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NPI Number | 1770070914
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Entity Type | Individual
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Provider Name | ANDRE JERMAINE TWINE CERTIFIEDHAIRLOSSSPE
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Gender | Male
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 943 S CEDAR RIDGE RD
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City | DALLAS
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State | TX
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Zip | 75137
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Country | US
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Telephone | 214-753-6757
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Fax |
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Provider Business Mailing Address
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Address Line | 934 S CEDAR RIDGE DR
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City | DUNCANVILLE
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State | TX
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Zip | 75137-2208
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Country | US
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Telephone |
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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