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General NPI Number Information
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NPI Number | 1861770984
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Entity Type | Organization
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Legal Business Name | COMMITTED 2 CARE FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 1410 CHARLESTOWN NEW ALBANY RD SUITE 103
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-9639
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Country | US
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Telephone | 812-590-1010
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Fax | 812-590-1014
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Provider Business Mailing Address
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Address Line | 1410 CHARLESTOWN NEW ALBANY RD SUITE 103
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-9639
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Country | US
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Telephone | 812-590-1010
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Fax | 812-590-1014
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHILOH A STOCKSDALE
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Credential | APRN
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Telephone | 812-590-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71002199A
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License Number State | IN
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