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General NPI Number Information
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NPI Number | 1871041731
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Entity Type | Individual
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Provider Name | AINESSE DESIR
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Gender | Female
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 20509 HOLLIS AVE
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City | SAINT ALBANS
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State | NY
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Zip | 11412-1417
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Country | US
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Telephone | 347-659-8939
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 228
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City | BAYSIDE
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State | NY
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Zip | 11361-0228
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Country | US
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Telephone | 347-659-8939
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 341609360401E
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License Number State | NY
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