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General NPI Number Information
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NPI Number | 1881109676
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Entity Type | Individual
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Provider Name | LINDSAY SAMUELSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/03/2017
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | 715 SW ANKENY RD
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City | ANKENY
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State | IA
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Zip | 50023-9798
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Country | US
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Telephone | 515-289-9703
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Fax |
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Provider Business Mailing Address
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Address Line | 2203 NE 13TH ST
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City | ANKENY
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State | IA
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Zip | 50021-7446
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A117394
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License Number State | IA
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