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General NPI Number Information
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NPI Number | 1922699156
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Entity Type | Organization
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Legal Business Name | AEDIFICARE, LLC
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Dates
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Enumeration Date | 01/30/2021
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 347 W OBRIEN DR STE 1
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City | HAGATNA
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State | GU
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Zip | 96910-5050
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Country | US
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Telephone | 671-682-0140
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Fax | 671-969-2726
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Provider Business Mailing Address
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Address Line | PO BOX 1733
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City | HAGATNA
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State | GU
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Zip | 96932-1733
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Country | US
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Telephone | 671-682-0140
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Fax | 671-969-2726
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Authorized Official
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Title or Position | CLINICIAN, OWNER
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Name | DIANNA M LE
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Credential | CPO, MSOP
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Telephone | 671-682-0140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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