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General NPI Number Information
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NPI Number | 1861149296
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Entity Type | Organization
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Legal Business Name | ULTIMATE PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 03/05/2022
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 216 COMMERCIAL ST NE
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City | SALEM
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State | OR
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Zip | 97301-3410
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Country | US
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Telephone | 614-804-0866
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Fax | 253-954-3116
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Provider Business Mailing Address
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Address Line | 22498 E TWIN ACRES DR
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-0609
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Country | US
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Telephone | 614-804-0866
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | ANNABEL OWUSU
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Credential |
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Telephone | 614-804-0866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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