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General NPI Number Information
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NPI Number | 1891453684
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Entity Type | Organization
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Legal Business Name | RVLWF MICHIGAN PLLC
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 42450 W 12 MILE RD STE 105
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City | NOVI
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State | MI
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Zip | 48377-3011
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Country | US
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Telephone | 248-970-1340
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Fax | 833-673-0185
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Provider Business Mailing Address
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Address Line | 10608 FLICKENGER LN
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City | KNOXVILLE
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State | TN
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Zip | 37922-3485
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Country | US
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Telephone | 865-392-6262
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Fax | 865-674-5089
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Authorized Official
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Title or Position | CEO
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Name | KATHRYN WALKER
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Credential | APRN CRNA
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Telephone | 865-392-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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