| Ipc Pac Healthcare Services Of Missouri Inc | |
|
12101 Woodcrest Executive Dr Suite 210 Saint Louis MO 63141-5047 | |
| (314) 317-0600 | |
| Not Available |
| Full Name | Ipc Pac Healthcare Services Of Missouri Inc |
|---|---|
| Speciality | Hospitalist |
| Location | 12101 Woodcrest Executive Dr, Saint Louis, Missouri |
| Authorized Official Name and Position | Randal Dabbs (PRESIDENT) |
| Authorized Official Contact | 8656931000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ipc Pac Healthcare Services Of Missouri Inc 265 Brookview Centre Way Ste 400 Knoxville TN 37919-4052 Ph: (865) 693-1000 | Ipc Pac Healthcare Services Of Missouri Inc 12101 Woodcrest Executive Dr Suite 210 Saint Louis MO 63141-5047 Ph: (314) 317-0600 |
| NPI Number | 1326497587 |
|---|---|
| Provider Enumeration Date | 06/08/2016 |
| Last Update Date | 07/29/2016 |
| Medicare PECOS PAC ID | 4587950589 |
|---|---|
| Medicare Enrollment ID | O20160830002898 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326497587 | NPI | - | NPPES |
| Provider Name | Ping Chang |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1124091194 PECOS PAC ID: 1355253006 Enrollment ID: I20031103000203 |
| Provider Name | Imran A Hanafi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588637516 PECOS PAC ID: 7618950155 Enrollment ID: I20040608000193 |
| Provider Name | Andrew C Dickler |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1306892468 PECOS PAC ID: 7012990419 Enrollment ID: I20040608000719 |
| Provider Name | Rajesh Swaminathan |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1720051527 PECOS PAC ID: 2769465863 Enrollment ID: I20040610000203 |
| Provider Name | Hana Alul |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568458412 PECOS PAC ID: 9234113309 Enrollment ID: I20040616000356 |
| Provider Name | Gopal K Nair |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952325789 PECOS PAC ID: 8426034414 Enrollment ID: I20040629000987 |
| Provider Name | Craig Stephen Siegel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295812733 PECOS PAC ID: 3870568876 Enrollment ID: I20040901001047 |
| Provider Name | Andrea M Holthaus |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528031473 PECOS PAC ID: 6608859038 Enrollment ID: I20041006000362 |
| Provider Name | Mehreen B Khann |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942292420 PECOS PAC ID: 2567422793 Enrollment ID: I20041013000101 |
| Provider Name | Omokhaye Mogokolea Higo |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1326120403 PECOS PAC ID: 8224098157 Enrollment ID: I20041015000007 |
| Provider Name | Sriram Vissa |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1558334573 PECOS PAC ID: 0143281675 Enrollment ID: I20041019000853 |
| Provider Name | Rajeshwar Peddi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043283989 PECOS PAC ID: 8729042544 Enrollment ID: I20041112000042 |
| Provider Name | Cesar Munoz |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1710979208 PECOS PAC ID: 8325023195 Enrollment ID: I20041119000957 |
| Provider Name | Mary Ann Lillig |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902899834 PECOS PAC ID: 9335107184 Enrollment ID: I20041227000198 |
| Provider Name | Michael J Cuipa |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1558335158 PECOS PAC ID: 8224087333 Enrollment ID: I20050115000027 |
| Provider Name | Lawrence Prablek |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407829344 PECOS PAC ID: 1557313780 Enrollment ID: I20050216000697 |
| Provider Name | Nadia Zia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134164825 PECOS PAC ID: 6709844277 Enrollment ID: I20050314000026 |
| Provider Name | Radhika Jaladi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376516302 PECOS PAC ID: 8729031521 Enrollment ID: I20050422000086 |
| Provider Name | Amanda E Avellone |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1154325082 PECOS PAC ID: 0446292072 Enrollment ID: I20050525000190 |
| Provider Name | Kenneth A Stein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164519757 PECOS PAC ID: 7214972678 Enrollment ID: I20050627000158 |
| Provider Name | Humayun Lodhi |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1386643492 PECOS PAC ID: 6002852886 Enrollment ID: I20050701000219 |
| Provider Name | Teresa L Gatton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437196953 PECOS PAC ID: 1052357647 Enrollment ID: I20050706000034 |
| Provider Name | Diana A Prablek |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588689541 PECOS PAC ID: 9335175066 Enrollment ID: I20050713000721 |
| Provider Name | James M Close |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1083641971 PECOS PAC ID: 7113823782 Enrollment ID: I20050719001220 |
| Provider Name | Anwer Z Rahman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326011354 PECOS PAC ID: 2668406646 Enrollment ID: I20050920000271 |
| Provider Name | Philip B Vaidyan |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1669445508 PECOS PAC ID: 0648204628 Enrollment ID: I20050920000285 |
| Provider Name | Lawrence Wells |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669430112 PECOS PAC ID: 2567419914 Enrollment ID: I20051004000119 |
| Provider Name | Jamal Makhoul |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1114904745 PECOS PAC ID: 3779504774 Enrollment ID: I20051216000581 |
| Provider Name | Sasibala S Vinjamoori |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801861497 PECOS PAC ID: 9830111707 Enrollment ID: I20051221000011 |
| Provider Name | Vicki J Carll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710902176 PECOS PAC ID: 6002838620 Enrollment ID: I20051227000002 |
| Provider Name | Joan H Mass |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295708162 PECOS PAC ID: 0244252112 Enrollment ID: I20051227000010 |
| Provider Name | William F Sudholt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164486254 PECOS PAC ID: 1759305378 Enrollment ID: I20060124000100 |
| Provider Name | Surajit Majumdar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548216179 PECOS PAC ID: 3870517196 Enrollment ID: I20060125000327 |
| Provider Name | Clayton E Thebeau |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194756148 PECOS PAC ID: 4880698679 Enrollment ID: I20060911000155 |
| Provider Name | April Thebeau |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144269424 PECOS PAC ID: 9931105418 Enrollment ID: I20061005000326 |
| Provider Name | Cynthia Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689740185 PECOS PAC ID: 8224130729 Enrollment ID: I20070302000008 |
| Provider Name | Marsha J Schulte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871537399 PECOS PAC ID: 0345343166 Enrollment ID: I20070316000047 |
| Provider Name | Pooja Patil |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1659457000 PECOS PAC ID: 0547363186 Enrollment ID: I20070320000068 |
| Provider Name | Lee Michael Demertzis |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1831298827 PECOS PAC ID: 3375648017 Enrollment ID: I20070425000118 |
| Provider Name | Dinko Naydenov |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1427186279 PECOS PAC ID: 3577669258 Enrollment ID: I20070427000015 |
| Provider Name | Umesh C Inampudi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427121227 PECOS PAC ID: 8820197718 Enrollment ID: I20070618000341 |
| Provider Name | Samuel A Chandra |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1124010772 PECOS PAC ID: 8123927894 Enrollment ID: I20070807000820 |
| Provider Name | Gina Iheonu Uzendu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740481142 PECOS PAC ID: 7012000334 Enrollment ID: I20070831000595 |
| Provider Name | Peter Shawki |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1659590479 PECOS PAC ID: 3678668399 Enrollment ID: I20070926000815 |
| Provider Name | Paolo Masetti |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1477651867 PECOS PAC ID: 1759463425 Enrollment ID: I20080204000144 |
| Provider Name | Lavada Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164691945 PECOS PAC ID: 8921184813 Enrollment ID: I20080318000257 |
| Provider Name | Aaliya Najib |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932399086 PECOS PAC ID: 5890887129 Enrollment ID: I20080410000384 |
| Provider Name | Sameer Rana |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1386642320 PECOS PAC ID: 5698701647 Enrollment ID: I20080614000117 |
| Provider Name | Olga Rudomiotov |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497965990 PECOS PAC ID: 8628141058 Enrollment ID: I20080718000192 |
| Provider Name | Sangita Aradhyula |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1356551915 PECOS PAC ID: 8022182435 Enrollment ID: I20080804000135 |
| Provider Name | Irim S Massay |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619931110 PECOS PAC ID: 0446283253 Enrollment ID: I20080813000867 |
| Provider Name | Venkata R Pante |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356314298 PECOS PAC ID: 4880769900 Enrollment ID: I20080823000059 |
| Provider Name | Takaaki Ishiyama |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1386865822 PECOS PAC ID: 6406924240 Enrollment ID: I20081007000662 |
| Provider Name | Stephanie N Piotter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649420233 PECOS PAC ID: 6204994379 Enrollment ID: I20081017000331 |
| Provider Name | Jacqueline J Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194704312 PECOS PAC ID: 7012076821 Enrollment ID: I20081110000072 |
| Provider Name | Randall C Speck |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912954033 PECOS PAC ID: 8527127331 Enrollment ID: I20081110000110 |
| Provider Name | Ravi K Donepudi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306041108 PECOS PAC ID: 8022179761 Enrollment ID: I20081212000395 |
| Provider Name | Mohammed Ashraf |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245213313 PECOS PAC ID: 9335119643 Enrollment ID: I20090105000279 |
| Provider Name | Jami Davis-jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629243886 PECOS PAC ID: 7810050804 Enrollment ID: I20090119000031 |
| Provider Name | Lacretia M Daniels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518103654 PECOS PAC ID: 0244395770 Enrollment ID: I20090218000038 |
| Provider Name | Thomas Wayne Fulbright |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548213119 PECOS PAC ID: 1557302080 Enrollment ID: I20090320000099 |
| Provider Name | Sabina Morga |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801016274 PECOS PAC ID: 9537257449 Enrollment ID: I20090420000175 |
| Provider Name | Heidi A Israel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912132283 PECOS PAC ID: 4082750385 Enrollment ID: I20090929000599 |
| Provider Name | Carol Ann Berger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003140328 PECOS PAC ID: 7012056245 Enrollment ID: I20091202000075 |
| Provider Name | Salwat Shami |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053579094 PECOS PAC ID: 7719027465 Enrollment ID: I20091210000697 |
| Provider Name | Lavondia L Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235460163 PECOS PAC ID: 2567597792 Enrollment ID: I20100312000853 |
| Provider Name | Nat T Levy |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1790777225 PECOS PAC ID: 8820994494 Enrollment ID: I20100618000781 |
| Provider Name | Olumide O Ogunremi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114990074 PECOS PAC ID: 7618008269 Enrollment ID: I20100626000226 |
| Provider Name | Nadeem N Sufi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1629041553 PECOS PAC ID: 8123938933 Enrollment ID: I20100626000243 |
| Provider Name | Latha M Myla |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1972576890 PECOS PAC ID: 3274665765 Enrollment ID: I20100720000003 |
| Provider Name | Mouner N Salem |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124091145 PECOS PAC ID: 4587796701 Enrollment ID: I20100722000874 |
| Provider Name | Cierra Nicole Dillard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649592296 PECOS PAC ID: 7012049232 Enrollment ID: I20100722000882 |
| Provider Name | Fatima A Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083687669 PECOS PAC ID: 9638201874 Enrollment ID: I20100723000008 |
| Provider Name | Felipe A Orellana |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922071877 PECOS PAC ID: 6608900725 Enrollment ID: I20100811000693 |
| Provider Name | John E Hartweger |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366443756 PECOS PAC ID: 9931233665 Enrollment ID: I20100817001345 |
| Provider Name | Jyotirmaya Nanda |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629039714 PECOS PAC ID: 6305970971 Enrollment ID: I20100818000391 |
| Provider Name | Laura A Adam |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1396954657 PECOS PAC ID: 2264566587 Enrollment ID: I20100823000007 |
| Provider Name | George A Lodoly |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1205828795 PECOS PAC ID: 5395648075 Enrollment ID: I20100826000510 |
| Provider Name | Ilir Polovina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952540999 PECOS PAC ID: 5991820102 Enrollment ID: I20100910001149 |
| Provider Name | Edgar Edison Galicia |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1801834494 PECOS PAC ID: 0345331997 Enrollment ID: I20100915000567 |
| Provider Name | Salvador Lobianco |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1871585356 PECOS PAC ID: 2466358031 Enrollment ID: I20100915000782 |
| Provider Name | Shilpa Bodhanampati |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982860888 PECOS PAC ID: 9537285036 Enrollment ID: I20100921001303 |
| Provider Name | Anjali Sanjeev Kamat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578729471 PECOS PAC ID: 6002008232 Enrollment ID: I20101006001114 |
| Provider Name | Bethany Noelle Catlett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437459666 PECOS PAC ID: 6002004124 Enrollment ID: I20101216000022 |
| Provider Name | Christine E Wilmsen Craig |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205145372 PECOS PAC ID: 7012196082 Enrollment ID: I20110122000044 |
| Provider Name | Alison Leigh Welch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265730899 PECOS PAC ID: 8224213053 Enrollment ID: I20110421000181 |
| Provider Name | Pablo Echeverria |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1922245125 PECOS PAC ID: 4183801970 Enrollment ID: I20110603000115 |
| Provider Name | Gibran Hamid Mahmud |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518132489 PECOS PAC ID: 6901077593 Enrollment ID: I20110912000050 |
| Provider Name | Anil Lakshman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366607798 PECOS PAC ID: 5698946309 Enrollment ID: I20110928000630 |
| Provider Name | Seow Voon Yew |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942518675 PECOS PAC ID: 3173795382 Enrollment ID: I20111012000697 |
| Provider Name | Donte Mcclary |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689647497 PECOS PAC ID: 9436063179 Enrollment ID: I20111117000148 |
| Provider Name | Lawrence Osei |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1093991887 PECOS PAC ID: 1557537552 Enrollment ID: I20111221000557 |
| Provider Name | Martha L Lapietra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932194925 PECOS PAC ID: 2365548054 Enrollment ID: I20120105000859 |
| Provider Name | Yee Ai See |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790068732 PECOS PAC ID: 7719153188 Enrollment ID: I20120106000099 |
| Provider Name | Jennifer Alonzo Doriman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023380847 PECOS PAC ID: 8325206147 Enrollment ID: I20120225000028 |
| Provider Name | Agnes C Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821360454 PECOS PAC ID: 2062672827 Enrollment ID: I20120402000388 |
| Provider Name | Leah A Majarocon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164706610 PECOS PAC ID: 0042471567 Enrollment ID: I20120410000667 |
| Provider Name | Nanette Quicho Delgiudice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093080434 PECOS PAC ID: 7719149590 Enrollment ID: I20120425000172 |
| Provider Name | Julie Kathryn Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326323767 PECOS PAC ID: 7113180464 Enrollment ID: I20120523000612 |
| Provider Name | Jesus Ceferino C Patino |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1528263969 PECOS PAC ID: 3779731484 Enrollment ID: I20120920000571 |
| Provider Name | Eileen O Lamb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710948468 PECOS PAC ID: 2062661440 Enrollment ID: I20120928000047 |
| Provider Name | Monu Khanna |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962432815 PECOS PAC ID: 3870595465 Enrollment ID: I20121009000807 |
| Provider Name | Julia C Bradbury |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700122306 PECOS PAC ID: 6406091115 Enrollment ID: I20130426000473 |
| Provider Name | Laura A Hughes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528346475 PECOS PAC ID: 1153563192 Enrollment ID: I20130805000263 |
| Provider Name | Jill Kolchinsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386950400 PECOS PAC ID: 4587844758 Enrollment ID: I20130816000194 |
| Provider Name | Callie M F Callahan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144565433 PECOS PAC ID: 6305099557 Enrollment ID: I20130827000435 |
| Provider Name | Jei Florensari Martin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033104047 PECOS PAC ID: 9537222872 Enrollment ID: I20131010001337 |
| Provider Name | Srikanth Nadella |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740599109 PECOS PAC ID: 9537396635 Enrollment ID: I20131217001298 |
| Provider Name | Peter Scott Emerson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023045655 PECOS PAC ID: 9739274226 Enrollment ID: I20131217001707 |
| Provider Name | Anitha Koduru |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689803785 PECOS PAC ID: 1153558820 Enrollment ID: I20131230001849 |
| Provider Name | Mian Rizwan |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1437380276 PECOS PAC ID: 0042460412 Enrollment ID: I20140228001479 |
| Provider Name | Jennifer L Hargis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124438932 PECOS PAC ID: 7618191081 Enrollment ID: I20140605001372 |
| Provider Name | Eyad Karzoun |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1649470196 PECOS PAC ID: 2466693403 Enrollment ID: I20140606001717 |
| Provider Name | Kristie Baker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124051941 PECOS PAC ID: 1850310269 Enrollment ID: I20140707000255 |
| Provider Name | Catharine A Kahrig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376957415 PECOS PAC ID: 4880819929 Enrollment ID: I20140707000262 |
| Provider Name | Debapriya De |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1215136197 PECOS PAC ID: 5496849465 Enrollment ID: I20140722000786 |
| Provider Name | Tamer A Dabous |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356506711 PECOS PAC ID: 0446476709 Enrollment ID: I20140722000905 |
| Provider Name | Hamid Kargbo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821231788 PECOS PAC ID: 3971731613 Enrollment ID: I20140805002136 |
| Provider Name | Kehinde F Hambolu |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1023439445 PECOS PAC ID: 0345467429 Enrollment ID: I20140813002109 |
| Provider Name | Manasa M Metireddy |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1023269701 PECOS PAC ID: 1153548466 Enrollment ID: I20140915001627 |
| Provider Name | Naga Neelima Nallapaneni |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1114155454 PECOS PAC ID: 8123249877 Enrollment ID: I20141021002050 |
| Provider Name | Adina Lumley Rey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336558014 PECOS PAC ID: 2062633324 Enrollment ID: I20141030000549 |
| Provider Name | Jennifer Rae Huckstep |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578969259 PECOS PAC ID: 3476877903 Enrollment ID: I20150109001898 |
| Provider Name | Akiko Okabe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073910162 PECOS PAC ID: 4789908724 Enrollment ID: I20150121001631 |
| Provider Name | Trista Calhoun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659787281 PECOS PAC ID: 5395060255 Enrollment ID: I20150303001020 |
| Provider Name | Leann Nitz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952701666 PECOS PAC ID: 2769709658 Enrollment ID: I20150403000349 |
| Provider Name | Rupinderjit Singh Dhillon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619167483 PECOS PAC ID: 6002940822 Enrollment ID: I20150428002301 |
| Provider Name | Kenneth E Remy |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1235345042 PECOS PAC ID: 5092971267 Enrollment ID: I20150504000764 |
| Provider Name | James L Paulsgrove |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982964607 PECOS PAC ID: 1658591326 Enrollment ID: I20150609000202 |
| Provider Name | Muhammed K Banday |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790071074 PECOS PAC ID: 8224260096 Enrollment ID: I20150730011302 |
| Provider Name | Madiha Koraishy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679882377 PECOS PAC ID: 0749424794 Enrollment ID: I20150730013477 |
| Provider Name | Jude Onaghise |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124376942 PECOS PAC ID: 3476783176 Enrollment ID: I20150806009865 |
| Provider Name | Mehwish Bilal |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1447596176 PECOS PAC ID: 9830404318 Enrollment ID: I20150812008108 |
| Provider Name | David M Picker |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1013228873 PECOS PAC ID: 3173770096 Enrollment ID: I20150903002503 |
| Provider Name | Jessica B Barks |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1720252190 PECOS PAC ID: 0244418929 Enrollment ID: I20150908002677 |
| Provider Name | Sumera Yaqub |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356653463 PECOS PAC ID: 8022327378 Enrollment ID: I20151027002580 |
| Provider Name | Amber Hodge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528436920 PECOS PAC ID: 7214246560 Enrollment ID: I20151027002934 |
| Provider Name | Kelly S Schokmiller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952786410 PECOS PAC ID: 6901115161 Enrollment ID: I20151029000738 |
| Provider Name | Anne Leslie Kramer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326441478 PECOS PAC ID: 0345564787 Enrollment ID: I20160211001437 |
| Provider Name | Asaph Githunguri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619340650 PECOS PAC ID: 4981909785 Enrollment ID: I20160216001124 |
| Provider Name | Amy Susan Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538533575 PECOS PAC ID: 0244537330 Enrollment ID: I20160405001595 |
| Provider Name | Syreeta Van Ross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063539823 PECOS PAC ID: 9436457546 Enrollment ID: I20160405002558 |
| Provider Name | Umaree Bybee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154788263 PECOS PAC ID: 7113225772 Enrollment ID: I20160414001171 |
| Provider Name | Kate Mueller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649697376 PECOS PAC ID: 2860791753 Enrollment ID: I20160427001453 |
| Provider Name | Noura Zakari |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346614161 PECOS PAC ID: 5799084422 Enrollment ID: I20160502002397 |
| Provider Name | Amy M Tolles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083076392 PECOS PAC ID: 5294024410 Enrollment ID: I20160511001556 |
| Provider Name | Hisham Taher |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1689824468 PECOS PAC ID: 0840461372 Enrollment ID: I20160523001228 |
| Provider Name | Ann Heatherly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598189615 PECOS PAC ID: 4082846373 Enrollment ID: I20160602000648 |
| Provider Name | Nitin Sainani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952745093 PECOS PAC ID: 8123327921 Enrollment ID: I20160803001307 |
| Provider Name | Cheng Chu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578824058 PECOS PAC ID: 6800198359 Enrollment ID: I20160815000392 |
| Provider Name | Kimberly Ann Galmore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255788923 PECOS PAC ID: 8628363322 Enrollment ID: I20160819000698 |
| Provider Name | Valerie Njuguna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811340508 PECOS PAC ID: 7416241872 Enrollment ID: I20160822001219 |
| Provider Name | Tahreem S Aziz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962847129 PECOS PAC ID: 6002058666 Enrollment ID: I20160906000108 |
| Provider Name | Evgeniy D Kulik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336503598 PECOS PAC ID: 8426344250 Enrollment ID: I20160906000123 |
| Provider Name | Kathe Ann Russo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629424965 PECOS PAC ID: 7911294483 Enrollment ID: I20160927001661 |
| Provider Name | Mana Hobson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851447049 PECOS PAC ID: 6507810736 Enrollment ID: I20161010000854 |
| Provider Name | Uyen Phan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427498286 PECOS PAC ID: 4688800063 Enrollment ID: I20161011002280 |
| Provider Name | Nadeem Najam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982669495 PECOS PAC ID: 9032178934 Enrollment ID: I20161018002488 |
| Provider Name | Warren O Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548718448 PECOS PAC ID: 2769770163 Enrollment ID: I20161018002774 |
| Provider Name | Geetha Jacob |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356898381 PECOS PAC ID: 2860770120 Enrollment ID: I20161021000196 |
| Provider Name | Sarah Z Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003269374 PECOS PAC ID: 6305124660 Enrollment ID: I20161021000241 |
| Provider Name | Dana M Loepker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225295967 PECOS PAC ID: 4789755083 Enrollment ID: I20161102000945 |
| Provider Name | Lucyanne Moraa Okwomi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508309329 PECOS PAC ID: 3971883240 Enrollment ID: I20161201001881 |
| Provider Name | Betty Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649725987 PECOS PAC ID: 8022398221 Enrollment ID: I20161205001928 |
| Provider Name | Manisha Shrestha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871035766 PECOS PAC ID: 7719267913 Enrollment ID: I20161205002080 |
| Provider Name | Sarah A. Payne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851833347 PECOS PAC ID: 9638458383 Enrollment ID: I20170103001643 |
| Provider Name | James E Burrow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659819688 PECOS PAC ID: 3072897230 Enrollment ID: I20170307001673 |
| Provider Name | Seema Sharma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467992057 PECOS PAC ID: 9335424530 Enrollment ID: I20170510002266 |
| Provider Name | Tia Tyler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235668153 PECOS PAC ID: 7012286958 Enrollment ID: I20170707002262 |
| Provider Name | Kevin Kuria |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033535968 PECOS PAC ID: 3870716509 Enrollment ID: I20170731001345 |
| Provider Name | Kelsy G Darby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740701804 PECOS PAC ID: 9739452509 Enrollment ID: I20170830003137 |
| Provider Name | Jeena Eapen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023018926 PECOS PAC ID: 2062483092 Enrollment ID: I20170906000708 |
| Provider Name | Tiffany L Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225565948 PECOS PAC ID: 2961777024 Enrollment ID: I20170929001116 |
| Provider Name | Sarah M Alderman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912904822 PECOS PAC ID: 8628193141 Enrollment ID: I20171101000050 |
| Provider Name | Heejin Kwon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144697400 PECOS PAC ID: 1052628922 Enrollment ID: I20171101000451 |
| Provider Name | David B Hughes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144490467 PECOS PAC ID: 8628155348 Enrollment ID: I20171215002036 |
| Provider Name | Kathleen Elizabeth Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104367283 PECOS PAC ID: 9830474949 Enrollment ID: I20171218000376 |
| Provider Name | Jacob Matthew Shepherd |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730574963 PECOS PAC ID: 7315249281 Enrollment ID: I20180621002795 |
| Provider Name | Tommel Samani |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1649651100 PECOS PAC ID: 7113214131 Enrollment ID: I20180924001685 |
| Provider Name | Ashley Blalock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679931414 PECOS PAC ID: 6103110606 Enrollment ID: I20181024001234 |
| Provider Name | Rose Wanjiru Njoroge-lassiter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396207403 PECOS PAC ID: 6103159199 Enrollment ID: I20190606000124 |
| Provider Name | Gewel G De Los Santos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205287737 PECOS PAC ID: 8921338880 Enrollment ID: I20190919002597 |
| Provider Name | Meredith Massler Figueroa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073911889 PECOS PAC ID: 0941524128 Enrollment ID: I20191022002493 |
| Provider Name | Lisa Carol Schweich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053739193 PECOS PAC ID: 2365667797 Enrollment ID: I20200316001091 |
| Provider Name | Sospeter O Otieno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609418763 PECOS PAC ID: 9436584406 Enrollment ID: I20200325002798 |
| Provider Name | Edith Kendi Muriuki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326718115 PECOS PAC ID: 7517365174 Enrollment ID: I20211012001922 |
| Provider Name | Concilia Amaonye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154736445 PECOS PAC ID: 2769875319 Enrollment ID: I20220203001772 |
| Provider Name | Shenella Carlisle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235641267 PECOS PAC ID: 8921353400 Enrollment ID: I20220324002272 |
| Provider Name | Francis Umunna Okafor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093457111 PECOS PAC ID: 1456728427 Enrollment ID: I20230119000766 |
| Provider Name | Bincy Joji |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396105656 PECOS PAC ID: 2961791488 Enrollment ID: I20230126001050 |
| Provider Name | Libby John |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598149932 PECOS PAC ID: 0345509345 Enrollment ID: I20230130001855 |
| Provider Name | Rachel Brooke Smith-langley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265834998 PECOS PAC ID: 5799007779 Enrollment ID: I20230201001614 |
| Provider Name | Deepa Nair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053725333 PECOS PAC ID: 4284856949 Enrollment ID: I20230208001953 |
| Provider Name | John Scallion |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154743151 PECOS PAC ID: 5092118612 Enrollment ID: I20230330000979 |
| Provider Name | Fonshay Latrice Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588814263 PECOS PAC ID: 0840354833 Enrollment ID: I20230414000079 |
| Provider Name | Kaely Marie Mayden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518658418 PECOS PAC ID: 7214390145 Enrollment ID: I20230825000375 |
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