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General NPI Number Information
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NPI Number | 1972769420
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Entity Type | Individual
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Provider Name | CHARIS RENEE GANT
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Gender | Female
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 5257 S WADSWORTH BLVD
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City | LITTLETON
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State | CO
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Zip | 80123-2228
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Country | US
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Telephone | 303-932-2005
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Fax |
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Provider Business Mailing Address
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Address Line | 2070 MORNINGVIEW LN
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City | CASTLE ROCK
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State | CO
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Zip | 80109-3662
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Country | US
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Telephone | 720-985-3071
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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 | 45046
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License Number State | CO
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