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General NPI Number Information
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NPI Number | 1801641139
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Entity Type | Organization
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Legal Business Name | SUMMIT RELIEF JH LLC
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Dates
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Enumeration Date | 04/19/2024
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 320 E BROADWAY AVE UNIT 1A
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City | JACKSON
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State | WY
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Zip | 83001-8636
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Country | US
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Telephone | 307-289-2525
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6580
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City | JACKSON
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State | WY
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Zip | 83002-6580
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Country | US
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Telephone | 307-289-2525
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARRIE ROSS QUINLAN
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Credential | FNP
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Telephone | 330-806-4427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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