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General NPI Number Information
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NPI Number | 1851065684
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Entity Type | Individual
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Provider Name | HAISE REARDON
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Gender | Female
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 208 E PLUME ST STE 213
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City | NORFOLK
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State | VA
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Zip | 23510-1757
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Country | US
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Telephone | 757-359-5521
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 WESSINGTON DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-6350
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Country | US
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Telephone |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AG08210024
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License Number State | VA
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