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General NPI Number Information
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NPI Number | 1922834142
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Entity Type | Organization
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Legal Business Name | ANGEL WINGS WELLNESS AND WEIGHTLOSS LLC
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 202 N CEDAR AVE STE 1
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City | OWATONNA
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State | MN
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Zip | 55060-2306
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Country | US
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Telephone | 952-208-5832
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD # 8316
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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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 | OWNER, AUTHORIZED OFFICIAL
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Name | ELIZABETH CHRISTINE BROWN
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Credential |
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Telephone | 507-571-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care 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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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