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Individual
THEODORA S PAINE
Active
Individual
THEODORA S PAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
398871-1
NY
363L00000X
Nurse Practitioner
F302183-1
NY
Other
Enumeration date
07/03/2006
Last updated
01/10/2014
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