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General NPI Number Information
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NPI Number | 1790545432
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Entity Type | Organization
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Legal Business Name | PROHEALTH PROVIDERS PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 7365 E 16TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-2308
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Country | US
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Telephone | 317-268-2199
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Fax |
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Provider Business Mailing Address
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Address Line | 230 S PERRY RD STE 1079
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City | PLAINFIELD
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State | IN
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Zip | 46168-2735
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Country | US
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Telephone | 317-268-2199
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MISS CHENAI MVUNDURA
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Credential | NP
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Telephone | 317-268-2199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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