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General NPI Number Information
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NPI Number | 1861280281
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Entity Type | Individual
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Provider Name | MICHAEL LUIS PUELLO CRNA
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Gender | Male
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Dates
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Enumeration Date | 04/26/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 1200 S CEDAR CREST BLVD FL 2
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City | ALLENTOWN
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State | PA
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Zip | 18103-6202
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Country | US
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Telephone | 610-402-6164
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Fax |
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Provider Business Mailing Address
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Address Line | 30 PROSPECT AVE
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City | HACKENSACK
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State | NJ
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Zip | 07601-1915
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Country | US
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Telephone | 551-996-2000
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR23761800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 26NJ15345300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN771569
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License Number State | PA
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