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General NPI Number Information
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NPI Number | 1801622634
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Entity Type | Individual
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Provider Name | CLOIE SOPHIA MIRAVITE ANTOLIN PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 1771 E FLAMINGO RD STE 210A
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City | LAS VEGAS
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State | NV
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Zip | 89119-8049
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Country | US
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Telephone | 725-243-4517
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Fax |
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Provider Business Mailing Address
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Address Line | 1771 E FLAMINGO RD STE 210A
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City | LAS VEGAS
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State | NV
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Zip | 89119-8049
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Country | US
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Telephone | 323-532-4678
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 829387
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License Number State | NV
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