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General NPI Number Information
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NPI Number | 1780168906
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Entity Type | Organization
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Legal Business Name | ELITE HEALTH AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 264 NW PEACOCK BLVD STE 103
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-2272
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Country | US
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Telephone | 772-777-8233
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Fax | 772-673-7710
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Provider Business Mailing Address
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Address Line | 264 NW PEACOCK BLVD STE 103
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-2272
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Country | US
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Telephone | 772-777-8233
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Fax | 772-673-7710
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Authorized Official
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Title or Position | ARNP
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Name | LOIS CASSLE
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Credential | ARNP
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Telephone | 772-777-8233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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