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General NPI Number Information
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NPI Number | 1962279216
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Entity Type | Individual
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Provider Name | HEATHER MYREE ANDERSON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 2100 N MAIN ST # 304
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City | CROWN POINT
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State | IN
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Zip | 46307-1877
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Country | US
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Telephone | 574-546-1900
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Fax | 574-546-1999
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Provider Business Mailing Address
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Address Line | 34 S MAIN ST
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City | CLOVERDALE
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State | IN
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Zip | 46120-8531
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Country | US
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Telephone | 888-837-5440
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Fax | 574-546-1999
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71014794A
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License Number State | IN
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