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General NPI Number Information
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NPI Number | 1902065287
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Entity Type | Individual
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Provider Name | JESSICA HAFNER DO
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Gender | Female
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 577 MICHIGAN AVE SUITE 202
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City | HOLLAND
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State | MI
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Zip | 49423-4911
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Country | US
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Telephone | 616-394-0673
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Fax |
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Provider Business Mailing Address
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Address Line | 175 S WAVERLY RD
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City | HOLLAND
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State | MI
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Zip | 49423-7907
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 5101017611
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License Number State | MI
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