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General NPI Number Information
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NPI Number | 1821604505
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Entity Type | Organization
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Legal Business Name | SHALONDA RENEE JOHNSON
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Dates
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Enumeration Date | 09/18/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 16506 FM 529 RD STE 115
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City | HOUSTON
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State | TX
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Zip | 77095-1463
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Country | US
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Telephone | 346-255-2192
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Fax | 832-201-7383
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Provider Business Mailing Address
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Address Line | 16506 FM 529 RD STE 115
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City | HOUSTON
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State | TX
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Zip | 77095-1463
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Country | US
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Telephone | 832-427-6743
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Fax | 832-201-7383
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHALONDA RENEE JOHNSON
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Credential | CPT
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Telephone | 832-427-6743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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