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General NPI Number Information
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NPI Number | 1932644630
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Entity Type | Individual
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Provider Name | MRS. ELAINE S RAAD
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Gender | Female
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 2814 ROUTE 20
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City | CORNWALLVILLE
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State | NY
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Zip | 12418-0117
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Country | US
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Telephone | 518-239-6895
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Fax |
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Provider Business Mailing Address
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Address Line | 709 LARKFIELD RD
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City | COMMACK
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State | NY
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Zip | 11725-2605
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Country | US
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Telephone | 239-266-4473
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN5226155
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 317253
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License Number State | NY
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