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Individual
MARK ANNA
Active
Individual
MARK ANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNPC
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
654183
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0075DJ
BLUE CROSS/BLUE SHIELD
TX
01
—
0082EV
BLUE CROSS/BLUE SHIELD
TX
05
—
063623501
—
TX
05
—
137227810
—
TX
Enumeration date
11/03/2005
Last updated
06/27/2008
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