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General NPI Number Information
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NPI Number | 1770098394
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Entity Type | Individual
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Provider Name | STACY PHILLIPS
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Gender | Female
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 571 ROCKROSE CT
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City | INCLINE VILLAGE
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State | NV
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Zip | 89451-8300
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Country | US
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Telephone | 805-704-7193
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 124
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City | MOFFETT FIELD
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State | CA
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Zip | 94035-0124
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Country | US
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Telephone | 805-704-7193
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | NU100000198
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License Number State | DC
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