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General NPI Number Information
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NPI Number | 1922463926
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Entity Type | Organization
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Legal Business Name | COMPLETE FAMILY CARE LLC
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Dates
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Enumeration Date | 12/18/2015
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 908 N HOWARD AVE SUITE 108
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City | GRAND ISLAND
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State | NE
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Zip | 68803-3556
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Country | US
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Telephone | 308-675-1931
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Fax |
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Provider Business Mailing Address
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Address Line | 908 N HOWARD AVE SUITE 108
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City | GRAND ISLAND
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State | NE
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Zip | 68803-3556
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Country | US
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Telephone | 308-675-1931
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MALCOLM LEAL CASTANEDA
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Credential |
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Telephone | 308-675-1931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 39208
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 110175
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License Number State | NE
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