LASTNAME,FIRSTNAME,MIDNAME,BUSNAME,GENERAL,SPECIALTY,UPIN,NPI,DOB,ADDRESS,CITY,STATE,ZIP,EXCLTYPE,EXCLDATE,REINDATE,WAIVERDATE,WVRSTATE
"","","","AMARA MEDICAL CENTER, LLC","OTHER BUSINESS","CLINIC","","1881298065","","4616 W SAHARA AVENUE, SUITE 48","LAS VEGAS","NV","89102","1128b8","20240919","00000000","00000000",""
"ABANDA","JACOB","ATAMBILI","","IND- LIC HC SERV PRO","NURSE PRACTITIONER (","","0000000000","19771212","12014 OSAGE PARK DRIVE","HOUSTON","TX","77065","1128b4","20240919","00000000","00000000",""
"ABDULLAH","PAULA","MARIE","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19680912","1616 N FLORIAN AVE","DECATUR","IL","62526","1128a1","20240919","00000000","00000000",""
"ACUNA","MICHAEL","RYAN","","IND- LIC HC SERV PRO","TECHNICIAN","","0000000000","19830207","3901 KLEIN BOULEVARD","LOMPOC","CA","93436","1128b4","20240919","00000000","00000000",""
"ADESANYA","ADEWALE","OPENYEMI","","INDIVIDUAL (UNAFFILI","NO KNOWN AFFILIATION","","0000000000","19830218","5349 KING ARTHUR CIR","ROSEDALE","MD","21237","1128a1","20240919","00000000","00000000",""
"AFZAL","AYESHA","TAHIR","","EMPLOYEE - PRIVATE S","DME - GENERAL","","0000000000","19890102","2016 DIXON ROAD","FREDERICK","MD","21704","1128a1","20240919","00000000","00000000",""
"AFZAL","MEHMOOD","A","","EMPLOYEE - PRIVATE S","DME - GENERAL","","0000000000","19900105","2016 DIXON ROAD","FREDERICK","MD","21704","1128a1","20240919","00000000","00000000",""
"AFZAL","TAHIR","","","BUS OWNER/EXEC","DME - GENERAL","","0000000000","19620223","2016 DIXON RD","FREDERICK","MD","21704","1128a1","20240919","00000000","00000000",""
"AGUILAR","KATHERINE","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19610915","5800 HICKORY CIR","SEDALIA","MO","65301","1128a3","20240919","00000000","00000000",""
"AHMED","FARHANA","K","","PHYSICIAN (MD, DO)","PAIN MANAGEMENT","","1649521774","19830710","5792 228TH STREET, FLOOR 2","OAKLAND GARDENS","NY","11364","1128a1","20240919","00000000","00000000",""
"AHMED","RIZWAN","","","BUS OWNER/EXEC","PHARMACY","","0000000000","19830626","106 SERPENTINE LN","ALBERTSON","NY","11507","1128a1","20240919","00000000","00000000",""
"AKHSHARUMOV","GAYK","","","BUS OWNER/EXEC","HOSPICE","","0000000000","19830926","3901 KLEIN BLVD","LOMPOC","CA","93436","1128a1","20240919","00000000","00000000",""
"AKINKUOTU","MECHILLE","RENEE","","IND- LIC HC SERV PRO","HEALTH CARE AIDE","","1154819555","19670330","7249 CAUSEWAY DRIVE, APT 1C","INDIANAPOLIS","IN","46214","1128a3","20240919","00000000","00000000",""
"AMAO","DAVID","","","INDIVIDUAL (UNAFFILI","RECRUITER/CAPPER","","0000000000","19820902","P O BOX 1000","LEWISBURG","PA","17837","1128a1","20240919","00000000","00000000",""
"AMMONS","ASHLEY","MICHAELA","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19940405","223 DRAKE AVE, APT 18","RIPLEY","TN","38063","1128b4","20240919","00000000","00000000",""
"AUZINE","DONALD","PETER JR","","PHYSICIAN (MD, DO)","PAIN MANAGEMENT","","1780752444","19700202","344 MARINE FORCES DR","GRAND PRAIRIE","TX","75051","1128a3","20240919","00000000","00000000",""
"AXEL","RACHAL","LORINE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19911105","9501 W SAHARA AVENUE, APT 2196","LAS VEGAS","NV","89117","1128b4","20240919","00000000","00000000",""
"BAILEY","CARRIE","ANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19880307","2321 DALLAS STREET","PORT CHARLOTTE","FL","33952","1128b4","20240919","00000000","00000000",""
"BALL","CRAIG","JAMES JR","","PHYSICIAN (MD, DO)","PLASTIC SURGERY","","1437370046","19490621","73335 TAMARISK ST","PALM DESERT","CA","92260","1128b4","20240919","00000000","00000000",""
"BARRERA-COLLIN","DEBRA","JOY","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19640210","3233 YUCCA LOOP, APT A","EAGLE PASS","TX","78852","1128b4","20240919","00000000","00000000",""
"BELL","VICTORIA","LEE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19651111","5983 FAIL RD","LA PORTE","IN","46350","1128a4","20240919","00000000","00000000",""
"BERNARDINI","RONALD","R","","IND- LIC HC SERV PRO","CHIROPRACTIC","","1639177918","19571028","201 PORTION ROAD, STE A","RONKONKOMA","NY","11779","1128b4","20240919","00000000","00000000",""
"BINFORD","HENRIETTA","","","BUS OWNER/EXEC","MENTAL/BEHAVIORAL HE","","0000000000","19681228","P O BOX 3725","ADELANTO","CA","92301","1128a1","20240919","00000000","00000000",""
"BOGONKO","THOMAS","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19601010","7209 NORTHERN LIGHTS CT","PLANO","TX","75074","1128b4","20240919","00000000","00000000",""
"BOOKER","SIOBAHAN","","","INDIVIDUAL (UNAFFILI","NO KNOWN AFFILIATION","","0000000000","19840311","P O BOX 3066","DECATUR","IL","62524","1128a3","20240919","00000000","00000000",""
"BOUIE","DOMINIQUE","N","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19890314","709 ARBOR ST","JOLIET","IL","60432","1128a1","20240919","00000000","00000000",""
"BROOKS","MATTHEW","HUNTER","","IND- LIC HC SERV PRO","PSYCHOLOGY","","1437482130","19830317","334 STATE ST","RENO","NV","89501","1128b4","20240919","00000000","00000000",""
"BROWN","SCOTT","MITCHELL","","IND- LIC HC SERV PRO","PHARMACY TECHNICIAN","","0000000000","19851220","P O BOX 999","BUTNER","NC","27509","1128a3","20240919","00000000","00000000",""
"BROWN","SHARINA","OLIVER","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19800130","112 E OAK HILL DR","PALATKA","FL","32177","1128b4","20240919","00000000","00000000",""
"BUGNI","HEATHER","MARIE","","EMPLOYEE - ST/LOC/TR","STATE GOV'T","","0000000000","19890507","1634 SCHLEY AVE","BUTTE","MT","59701","1128b1","20240919","00000000","00000000",""
"BURACK","STEVEN","ADAM","","PHYSICIAN (MD, DO)","PAIN MANAGEMENT","","1639220064","19721228","P O BOX 1000","OTISVILLE","NY","10963","1128a1","20240919","00000000","00000000",""
"BURNETT","MAE","JEANETTE","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19740503","32 FORGOTTEN LN 2","WAYNESBORO","VA","22980","1128a1","20240919","00000000","00000000",""
"BUTLER","AMY","JO","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19770924","2223 HIGHWAY CC","CAIRO","MO","65239","1128b4","20240919","00000000","00000000",""
"CAHOON","BENJAMIN","PAUL","","IND- LIC HC SERV PRO","OPTOMETRY","","1053819557","19810602","36142 COFFEE TREE PL","MURRIETA","CA","92562","1128b4","20240919","00000000","00000000",""
"CALHOUN","AMBERLYNN","MARIE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19920722","314 POLIN ROAD","FULTONVILLE","NY","12072","1128b4","20240919","00000000","00000000",""
"CALL","KEVIN","CHARLES","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19800528","2011 HILL STREET","KAYSVILLE","UT","84037","1128b4","20240919","00000000","00000000",""
"CANDIDO","CAMILLO","MARTINEZ","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1306308283","19890821","75 BEHR AVE, APT 104","SAN FRANCISCO","CA","94131","1128b4","20240919","00000000","00000000",""
"CARTER","BRADLEY","JAMES","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19830610","270 N GAIL STREET","HOLLIDAYSBURG","PA","16648","1128b4","20240919","00000000","00000000",""
"CARUTHERS","JESSICA","CONSHONTI","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19931009","1601 SW 27TH AVENUE, APT 2001","OCALA","FL","34471","1128a4","20240919","00000000","00000000",""
"CASTILLO","KELLY","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","000000","0000000000","19790309","N7701 LAURA LANE","ELKHORN","WI","53121","1128a3","20240919","00000000","00000000",""
"CASTRO SOLANO","THALIA","TAYLOR","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","20010604","961 ALMADEN ST","EUGENE","OR","97402","1128a1","20240919","00000000","00000000",""
"CAUGHEY","CURTIS","LEE","","PHYSICIAN (MD, DO)","EMERGENCY MEDICINE","","1447203880","19530718","361 RUE MARSEILLE, APT 102","DAYTON","OH","45429","1128b4","20240919","00000000","00000000",""
"CESAR","TANIA","","","IND- LIC HC SERV PRO","PHYSICAL THERAPY","","1821388877","19681009","GLEN RAY ROAD BOX A","ALDERSON","WV","24910","1128a3","20240919","00000000","00000000",""
"CHAN","VICTORIA","TING","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19610606","146 TOPEKA CT","MANTECA","CA","95337","1128b4","20240919","00000000","00000000",""
"CHOW","MITCHELL","","","BUS OWNER/EXEC","MARKETING FIRM","","0000000000","19760312","4004 EAST ARKONA ROAD","MILAN","MI","48160","1128a1","20240919","00000000","00000000",""
"CLARK","ANDREASTASHA","R","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19891223","3500 WALDEN ST, APT 201","AURORA","CO","80011","1128b4","20240919","00000000","00000000",""
"COBLE","ROBERT","V","","PHYSICIAN (MD, DO)","EMERGENCY MEDICINE","","1477594455","19461113","11220 MINOR HILL HWY, APT HY","GOODSPRING","TN","38460","1128b4","20240919","00000000","00000000",""
"COLE","BRADLEY","WAYNE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19831221","467 MOUNT WILLIE ROAD","JUNCTION CITY","AR","71749","1128b4","20240919","00000000","00000000",""
"COLLIER","JENNIFER","L","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19831116","121 SUNSET LN","GATE CITY","VA","24251","1128b4","20240919","00000000","00000000",""
"COLLINS","DIANA","MARIE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19630921","37529 BINGO BLVD,  LOT 177","ZEPHYRHILLS","FL","33541","1128a2","20240919","00000000","00000000",""
"COOKSON","JANET","G","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19740708","13610 CRADLE HILL ROAD","MIDLOTHIAN","VA","23112","1128b4","20240919","00000000","00000000",""
"COPELAND","TRAE","","","IND- LIC HC SERV PRO","THERAPIST","","0000000000","19930308","1509 TRAMWAY CT","MIDWAY PARK","NC","28544","1128b4","20240919","00000000","00000000",""
"CROFF","HOLLY","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19611010","501  SAGUARO DRIVE","WICKENBURG","AZ","85390","1128a1","20240919","00000000","00000000",""
"CURTIS","SUSAN","ELISABETH","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19841108","513 S DODSON ROAD, APT L1","ROGERS","AR","72758","1128b4","20240919","00000000","00000000",""
"DEL RIO","OMAR","NARANJO","","BUS OWNER/EXEC","DME - GENERAL","","0000000000","19780531","P O BOX 019120","MIAMI","FL","33101","1128a1","20240919","00000000","00000000",""
"DENSON","SHOMARI","MIKEL","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19980401","P O BOX 1907","PINELLAS PARK","FL","33780","1128b4","20240919","00000000","00000000",""
"DENT","JAMES","EARL III","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19770308","2249 S 15TH ST","SPRINGFIELD","IL","62703","1128a1","20240919","00000000","00000000",""
"DESOUZA","ANTHONY","JUSTIN","","IND- LIC HC SERV PRO","NURSE PRACTITIONER (","","1265890149","19760312","5301 E COMMERCE WAY, UNIT 6110","SACRAMENTO","CA","95835","1128b4","20240919","00000000","00000000",""
"DI FLAVIA","GRACIELA","MABEL","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19570512","11439 SEVEN SISTER DRIVE","TOMBALL","TX","77375","1128b4","20240919","00000000","00000000",""
"DILLEHAY","KAREN","AMANDA","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19850308","3133 BATAVIA ST","DULUTH","MN","55806","1128b4","20240919","00000000","00000000",""
"DOERWALD","MICHELE","LYDIA","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19580226","7102 HAAS AVE","LOS ANGELES","CA","90047","1128b4","20240919","00000000","00000000",""
"DRYDEN","CLAYTON","EARL","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19911013","2820 US HIGHWAY 2 W","KALISPELL","MT","59901","1128a3","20240919","00000000","00000000",""
"DUROSEAU","VILAIRE","CLUNY","","BUS OWNER/EXEC","NURSING FIRM","","0000000000","19650616","P O BOX 1000","WHITE DEER","PA","17887","1128a3","20240919","00000000","00000000",""
"ELLENBOLT","DARREN","RICHARD","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1700855012","19770203","905 PINEHURST CT, APT 207","BROOKFIELD","WI","53005","1128b4","20240919","00000000","00000000",""
"ELLISS","MARIA","T","","IND- LIC HC SERV PRO","HEALTH CARE AIDE","","0000000000","19821016","825 32ND AVENUE, APT 55","LONGVIEW","WA","98632","1128b4","20240919","00000000","00000000",""
"EMBWAGA","CHEPCHUMBA","S","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19830415","504 HERITAGE TRL","JORDAN","MN","55352","1128b4","20240919","00000000","00000000",""
"ENDICOTT","THOMAS","ANDRE","","IND- LIC HC SERV PRO","DENTIST","","1124261623","19530828","9809 W WESCOTT DRIVE","PEORIA","AZ","85382","1128b4","20240919","00000000","00000000",""
"ESCOBAR","TARANEH","REZAEI","","IND- LIC HC SERV PRO","THERAPIST","","1295994267","19630220","8099 NW 71ST COURT","FORT LAUDERDALE","FL","33321","1128b4","20240919","00000000","00000000",""
"EVANS","STANLEY","CHARLES","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1790781797","19590618","P O BOX 9000","SEAGOVILLE","TX","75159","1128a1","20240919","00000000","00000000",""
"FATELEY","ROSE","M'LYNN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19950809","5000 CLINTON PKWY, APT 1404","LAWRENCE","KS","66047","1128a1","20240919","00000000","00000000",""
"FIGUEROA","TRINA","MARIE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19871011","8820 W GROVERS AVE","PEORIA","AZ","85382","1128b4","20240919","00000000","00000000",""
"FORD","AIRYONA","","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","1073137352","19910814","870 OLD COACH ROAD","WESTERVILLE","OH","43081","1128a1","20240919","00000000","00000000",""
"FORKPA","CATHERINE","","","INDIVIDUAL (UNAFFILI","NO KNOWN AFFILIATION","","0000000000","19910524","317 S 19TH STREET, APT 26","WEST DES MOINES","IA","50265","1128a2","20240919","00000000","00000000",""
"FOX","ALLISON","CASE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1780026948","19790610","3320 LANDMARK DRIVE","MORRISTOWN","TN","37814","1128b4","20240919","00000000","00000000",""
"FRANCE","ANGELINA","MARIE","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19900414","863 NEWTON LN","GALLATIN","TN","37066","1128b1","20240919","00000000","00000000",""
"FROST","MICHELE","ANDREA","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19891230","74 ANTLER TRAIL CV","RED BANKS","MS","38661","1128b4","20240919","00000000","00000000",""
"GALLENTINE","JONI","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19810527","3313 MARK TWAIN DR","SAINT JOSEPH","MO","64501","1128b4","20240919","00000000","00000000",""
"GARDNER","WILLIAM","C","","IND- LIC HC SERV PRO","DENTIST","","1003905043","19691209","5533 VIA CONEJO NE","ALBUQUERQUE","NM","87111","1128a3","20240919","00000000","00000000",""
"GENNA","GARY","NICHOLAS","","IND- LIC HC SERV PRO","THERAPIST","","0000000000","19590224","7937 WHEATLAND DR","KNOXVILLE","TN","37931","1128b4","20240919","00000000","00000000",""
"GOODFRIEND","DANIELLE","NICOLE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19860827","2140 W YELLOW BIRD ROAD, STE 4","YUCCA","AZ","86438","1128b4","20240919","00000000","00000000",""
"GRIFFIN","JOHNATHAN","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19930430","9792 MS HIGHWAY 9","BELLEFONTAINE","MS","39737","1128b4","20240919","00000000","00000000",""
"HAHN","WENDY","SUE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19701216","5259 BOY SCOUT RD","INDIANAPOLIS","IN","46226","1128a4","20240919","00000000","00000000",""
"HALE","MEREDITH","ANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19880109","5321 N VINE ST","NORTH LITTLE ROCK","AR","72116","1128b4","20240919","00000000","00000000",""
"HAMMER","LUANA","SUE","","IND- LIC HC SERV PRO","TECHNICIAN","","0000000000","19660811","2169 STABORN DR","BELOIT","WI","53511","1128b4","20240919","00000000","00000000",""
"HANSEN","JOEL","THOMAS","","IND- LIC HC SERV PRO","SOCIAL WORKER","","1447519194","19810808","5272 STAGECOACH TRL N","STILLWATER","MN","55082","1128b4","20240919","00000000","00000000",""
"HARRISON","MATTHEW","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19850628","203 BREWSTER STREET","FORDYCE","AR","71742","1128b4","20240919","00000000","00000000",""
"HARTLEY","JOHN","MATTHEW","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19681209","9731 W HORSE THIEF PASS","TOLLESON","AZ","85353","1128a2","20240919","00000000","00000000",""
"HEAD","LERENZO","","","EMPLOYEE - PRIVATE S","ADULT HOME","","0000000000","19841022","1282 LEAR LANE, UNIT 14","HOBART","WI","54115","1128a1","20240919","00000000","00000000",""
"HEIST","LAURA","ANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19660520","80 UINTA WAY, APT 208","DENVER","CO","80230","1128b4","20240919","00000000","00000000",""
"HENDRICKSON-AXINTE","AMY","MARIE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19650114","1415 HAWTHORNE DRIVE","CEDAR FALLS","IA","50613","1128a3","20240919","00000000","00000000",""
"HENRY","RUTH","N","","EMPLOYEE - PRIVATE S","HOME HEALTH AGENCY","","0000000000","19600307","209 MEADOW CREEK DR","COLUMBIA","SC","29203","1128a1","20240919","00000000","00000000",""
"HEUGEL","HEATHER","AMANDA","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19850719","6388 OYSTER KEY LN","PLAINFIELD","IN","46168","1128a4","20240919","00000000","00000000",""
"HIDALGO","JORDAN","DOUGLAS","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19840924","9900 WILBUR MAY PKWY, APT 3106","RENO","NV","89521","1128b4","20240919","00000000","00000000",""
"HILDEBRANDT","JODI","NAN","","IND- LIC HC SERV PRO","COUNSELOR","","0000000000","19690618","P O BOX 165300","SALT LAKE CITY","UT","84116","1128b4","20240919","00000000","00000000",""
"HOANG","MARC","THANH","","IND- LIC HC SERV PRO","PHARMACIST","","0000000000","19710127","5872 GUNDRY AVE","LONG BEACH","CA","90805","1128a4","20240919","00000000","00000000",""
"HORTON","KRISTIN","MARY","","IND- LIC HC SERV PRO","COUNSELOR","","0000000000","19790223","19 PAIGE DR","STAUNTON","VA","24401","1128b4","20240919","00000000","00000000",""
"HOUSE","MELISSA","BETH","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19821130","410 BELOHLAVY DR","CRETE","NE","68333","1128b4","20240919","00000000","00000000",""
"HUNTER","JACQUELINE","HENLEY","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19770427","179 HEDGES LN, APT 101","ASHLAND CITY","TN","37015","1128b4","20240919","00000000","00000000",""
"ITAMAN","ANNA","HONORATA","","IND- LIC HC SERV PRO","NURSE PRACTITIONER (","","1972189280","19641028","907 POLLARD STREET, B","HOUSTON","TX","77020","1128a3","20240919","00000000","00000000",""
"ITAMAN","SIMON","OSARENREN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19601028","7601 DEBEAUBIEN DRIVE","ORLANDO","FL","32385","1128a3","20240919","00000000","00000000",""
"IWAS","HASNA","BASHIR","","BUS OWNER/EXEC","PHARMACY","","1144787003","19610506","P O BOX 14525","LEXINGTON","KY","40512","1128a4","20240919","00000000","00000000",""
"JACKSON","CLARENCE","CHOKI","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19870317","3724 MALLARD DR","OKLAHOMA CITY","OK","73115","1128b4","20240919","00000000","00000000",""
"JAIN","ASHOK","","","PHYSICIAN (MD, DO)","PSYCHIATRY","","1780680470","19610702","P O BOX 1010","BASTROP","TX","78602","1128a1","20240919","00000000","00000000",""
"JAWORSKI","MAVIS","WEBSTER","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1154483931","19570323","351 EDWIN DRIVE, SUITE 102","VIRGINIA BEACH","VA","23462","1128b4","20240919","00000000","00000000",""
"JEAN","LUDNIE","","","BUS OWNER/EXEC","NURSING FIRM","","0000000000","19630319","4729 N CASHEL CIRCLE","HOUSTON","TX","77069","1128a3","20240919","00000000","00000000",""
"JENKINS","DAPHNE","CAROL","","IND- LIC HC SERV PRO","NURSE PRACTITIONER (","","1659439651","19590429","GLEN RAY ROAD, BOX A","ALDERSON","WV","24910","1128a1","20240919","00000000","00000000",""
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