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General NPI Number Information
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NPI Number | 1811785876
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Entity Type | Individual
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Provider Name | MADELAINE MARIE HEIDEMAN
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Gender | Female
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 215 5TH ST
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City | MARIETTA
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State | OH
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Zip | 45750-4033
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Country | US
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Telephone | 740-376-4986
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Fax |
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Provider Business Mailing Address
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Address Line | 1375 W 1980 N
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City | PROVO
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State | UT
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Zip | 84604-2224
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Country | US
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Telephone | 801-830-3522
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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 | 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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