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General NPI Number Information
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NPI Number | 1982502506
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Entity Type | Organization
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Legal Business Name | RESTORATION FAMILY HEALTH
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Dates
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Enumeration Date | 10/26/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 2424 BONITA ST
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City | CARLSBAD
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State | NM
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Zip | 88220-3152
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Country | US
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Telephone | 575-318-3673
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Fax |
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Provider Business Mailing Address
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Address Line | 2424 BONITA ST
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City | CARLSBAD
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State | NM
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Zip | 88220-3152
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Country | US
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Telephone | 575-318-3673
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | LIZA TACKETT
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Credential |
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Telephone | 575-399-3468
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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 |
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License Number State |
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