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General NPI Number Information
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NPI Number | 1790177491
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Entity Type | Organization
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Legal Business Name | FULL CIRCLE PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 8101 O ST STE 118
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City | LINCOLN
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State | NE
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Zip | 68510-2647
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Country | US
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Telephone | 402-217-9098
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Fax |
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Provider Business Mailing Address
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Address Line | 8101 O ST STE 118
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City | LINCOLN
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State | NE
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Zip | 68510-2647
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Country | US
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Telephone | 402-217-9098
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEANNE ISAACSON
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Credential | PAC
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Telephone | 402-217-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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