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General NPI Number Information
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NPI Number | 1861816860
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Entity Type | Individual
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Provider Name | VANESSA MIRASOL DPM
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Gender | Female
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 400 VETERANS AVE
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City | BILOXI
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State | MS
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Zip | 39531
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Country | US
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Telephone | 228-523-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 356 GINGER DR BOX 7414
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City | DIBERVILLE
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State | MS
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Zip | 39540-9081
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Country | US
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Telephone | 228-760-1235
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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 | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | P205
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License Number State | HI
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