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General NPI Number Information
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NPI Number | 1821800228
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Entity Type | Individual
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Provider Name | CHLOE NISSI MOLE JAMERO
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Gender | Female
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 790 SONOMA AVE
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City | SANTA ROSA
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State | CA
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Zip | 95404-4713
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Country | US
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Telephone | 707-360-4368
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Fax |
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Provider Business Mailing Address
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Address Line | 2403 PROFESSIONAL DR
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City | SANTA ROSA
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State | CA
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Zip | 95403-3007
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Country | US
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Telephone | 707-544-3295
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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