LASTNAME,FIRSTNAME,MIDNAME,BUSNAME,GENERAL,SPECIALTY,UPIN,NPI,DOB,ADDRESS,CITY,STATE,ZIP,EXCLTYPE,EXCLDATE,REINDATE,WAIVERDATE,WVRSTATE
"","","","APACHE HEALTH LLC","OTHER BUSINESS","PSYCHOLOGIC PRACTICE","","1154936953","","110 S IDAHO ROAD","APACHE JUNCTION","AZ","85119","1128a1","20241020","00000000","00000000",""
"","","","IMPACT THERAPY, LLC","OTHER BUSINESS","SUBSTANCE ABUSE REHA","","1881025641","","3450 W CENTRAL AVE, STE 354","TOLEDO","OH","43606","1128a1","20241020","00000000","00000000",""
"","","","SOLID DIAGNOSTICS, INC","OTHER BUSINESS","LABORATORY-IDTF","","1962044164","","30 WINDMILL DRIVE","SUDBURY","MA","01776","1128a1","20241020","00000000","00000000",""
"ABED","HUSAM","THAMIN","","PHYSICIAN (MD, DO)","UROLOGY","","1053332296","19691001","12025 INA DRIVE, UNIT 98","STERLING HEIGHTS","MI","48312","1128a2","20241020","00000000","00000000",""
"ADAMS","JACQUELINE","CHAVONNE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1790410611","19871030","5620 GREY STREET","NEW PORT RICHEY","FL","34652","1128b4","20241020","00000000","00000000",""
"ADELAKUN","ABIODUN","AVEEZ","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19751205","604 CORBIN CIR SW","PALM BAY","FL","32908","1128b4","20241020","00000000","00000000",""
"AGHALOO","JAVAD","","","BUS OWNER/EXEC","DENTAL PRACTICE","","1073708582","19730925","3901 KLEIN BLVD","LOMPOC","CA","93436","1128a1","20241020","00000000","00000000",""
"AKHVERDYAN","PARUYR","","","BUS OWNER/EXEC","HOSPICE","","0000000000","19660417","17508 TROSA STREET","GRANADA HILLS","CA","91344","1128a1","20241020","00000000","00000000",""
"AKONKOH","JOHN","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19690510","1101 LINDEN LANE","FARIBAULT","MN","55021","1128a2","20241020","00000000","00000000",""
"ALCAIN","JANE","ANDALLO","","BUS OWNER/EXEC","HOSPICE","","0000000000","19650326","P O BOX 3725","ADELANTO","CA","92301","1128a1","20241020","00000000","00000000",""
"ALLEN","AMANDA","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19840122","2118 FAIRHAVEN DR","SAINT LOUIS","MO","63136","1128b4","20241020","00000000","00000000",""
"ALSHAFEY","ZAMAN","","","IND- LIC HC SERV PRO","PHARMACIST","","0000000000","19870701","P O BOX 1000","MILAN","MI","48160","1128a3","20241020","00000000","00000000",""
"AMANATULLAH","MARIROSE","CHRISTINE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19821005","11845 N HAM LANE","LODI","CA","95242","1128b4","20241020","00000000","00000000",""
"ANDERSON","KATIE","ANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19801005","4347 51ST STREET S","FARGO","ND","58104","1128b4","20241020","00000000","00000000",""
"ANDREWS","STEPHEN","KEITH","","BUS OWNER/EXEC","DME - GENERAL","","0000000000","19730416","MAXWELL AIR FORCE BASE","MONTGOMERY","AL","36112","1128a3","20241020","00000000","00000000",""
"APAU","RICHARD","KAUKAPONO","","PHYSICIAN (MD, DO)","GENERAL PRACTICE","","1326114943","19570211","843 9TH AVENUE","HONOLULU","HI","96816","1128b4","20241020","00000000","00000000",""
"AUSTIN","RICHARD","LEE JR","","PHYSICIAN (MD, DO)","GENERAL PRACTICE","","1275519589","19520305","P O BOX 705","SOLEDAD","CA","93960","1128b4","20241020","00000000","00000000",""
"AUSTIN","RICHARD","PATRICK","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19840810","P O BOX 154","RATCLIFF","TX","75858","1128b4","20241020","00000000","00000000",""
"AVILA ROMERO","MARCO","TULIO","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19701231","2755 25TH STREET","SARASOTA","FL","34234","1128b4","20241020","00000000","00000000",""
"BAILEY","CHRISTINA","RENAY","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1053944637","19840903","3003 CANTABRIAN DRIVE, APT A","KILLEEN","TX","76542","1128b4","20241020","00000000","00000000",""
"BAILEY","CINDY","MARIE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19730628","2729 DUNCAN STREET","SAINT JOSEPH","MO","64507","1128b4","20241020","00000000","00000000",""
"BAKARI","JULIUS","","","BUS OWNER/EXEC","COMM MNTL HLTH CNTR","","1023262730","19771120","P O BOX 2000","BRUCETON MILLS","WV","26525","1128a1","20241020","00000000","00000000",""
"BALDWIN","STEPHEN","DOUGLAS","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19781219","8100 HIGHWAY 64 EAST","AVON PARK","FL","33825","1128b4","20241020","00000000","00000000",""
"BALGER","ABIGAIL","","","PHYSICIAN (MD, DO)","EMERGENCY MEDICINE","","1265697478","19790722","805 E GENEVA DR","DEWITT","MI","48820","1128a1","20241020","00000000","00000000",""
"BANKS","CHRISTOPHER","R JR","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19780416","79 EAST COLLOM STREET","PHILADELPHIA","PA","19144","1128a1","20241020","00000000","00000000",""
"BARBER","STEPHANIE","MARLENE","","IND- LIC HC SERV PRO","PHYSICAL THERAPY","","0000000000","19831003","7933 WEST DRIVE, APT 507","NORTH BAY VILLAGE","FL","33141","1128b4","20241020","00000000","00000000",""
"BARGEN","RICHARD","ALLAN","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1760649271","19471113","1885 STEVEN DR","FALLON","NV","89406","1128b4","20241020","00000000","00000000",""
"BAUTISTA","CHAY","NICOLE","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19840802","P O BOX 1284","BALD KNOB","AR","72010","1128b1","20241020","00000000","00000000",""
"BELL","ANTHONY","DUANE SR","","BUS OWNER/EXEC","DME - ORTHOTICS","","0000000000","19680706","P O BOX 1000","DULUTH","MN","55814","1128a1","20241020","00000000","00000000",""
"BELL","PAMELA","","","BUS OWNER/EXEC","COUNSELING CENTER","","1922238559","19641009","404 LAKEWOOD DRIVE","SEARCY","AR","72143","1128a1","20241020","00000000","00000000",""
"BERGSTROM","BENJAMIN","SCOTT","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1992358550","19800623","2440 WINNE AVENUE, STE 100","HELENA","MT","59601","1128b4","20241020","00000000","00000000",""
"BIRITZ","DAVID","JOHN MCMICHEAL","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19751019","4526 FAIRMOUNT AVE","KANSAS CITY","MO","64111","1128b4","20241020","00000000","00000000",""
"BISHOP","MARK","DOUGLAS","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1225196579","19591206","32724 TUSSOCK DRIVE","LAUREL","DE","19956","1128b4","20241020","00000000","00000000",""
"BLACKWELL","ANTOYA","LAKOLE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19851007","2503 HARVEST CREEK","SAN ANTONIO","TX","78244","1128b4","20241020","00000000","00000000",""
"BLADOW","SHELLY","RENEE","","IND- LIC HC SERV PRO","NURSE PRACTITIONER (","","0000000000","19651028","11572 CARRIGE CT","EDEN PRAIRIE","MN","55344","1128b4","20241020","00000000","00000000",""
"BOHANON","KRYSTAL","C","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19900801","3314 WALTER RD","NORTH OLMSTED","OH","44070","1128a2","20241020","00000000","00000000",""
"BORINSKI","LINDSAY","ANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19880623","6965 GOLFCREST DR, APT 3063","SAN DIEGO","CA","92119","1128b4","20241020","00000000","00000000",""
"BORRIS","WILLIAM","MICHAEL","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1083984629","19391214","11812 KEMPER OAKS CT","AUBURN","CA","95603","1128b4","20241020","00000000","00000000",""
"BRADSTREET","MALAINE","DAWN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19711102","11100 HINSHAW DRIVE","MUSTANG","OK","73064","1128b4","20241020","00000000","00000000",""
"BRECHT","KRISTINE","SUSANNE","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1922071802","19730528","12843 SHORECREST DR SW","SEATTLE","WA","98146","1128b4","20241020","00000000","00000000",""
"BRITTON","KIMBERLY","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19801223","108 N BOWIE DRIVE","WEATHERFORD","TX","76086","1128b4","20241020","00000000","00000000",""
"BROWN","KEVIN","MICHAEL","","IND- LIC HC SERV PRO","CHIROPRACTIC","","1700426467","19800208","30152 W FLORIDA AVE","HEMET","CA","92545","1128b7","20240710","00000000","00000000",""
"BROWN","RENITA","GAIL","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1801102959","19581130","333 RAILROAD AVENUE, E","GADSDEN","AL","35905","1128a1","20241020","00000000","00000000",""
"BRUMSEY","TRACY","BERNARD","","EMPLOYEE - PRIVATE S","HOME HEALTH AGENCY","","0000000000","19651124","21 FM 247","HUNTSVILLE","TX","77320","1128a1","20241020","00000000","00000000",""
"BRYAN","SAMANTHA","L","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19941126","78 SAM ALLEN ROAD","SANFORD","ME","04073","1128a1","20241020","00000000","00000000",""
"BURROUGHS","HUNTER","MATTHEW","","BUS OWNER/EXEC","DME - GENERAL","","0000000000","19790731","P O BOX 1000","DULUTH","MN","55814","1128a3","20241020","00000000","00000000",""
"BUTLER","AISHA","MARIE","","BUS OWNER/EXEC","MENTAL/BEHAVIORAL HE","","1134433345","19750201","9245 WORSLEY PARK PLACE","LAS VEGAS","NV","89145","1128a1","20241020","00000000","00000000",""
"BUTLER","MARK","ORVAL","","PHYSICIAN (MD, DO)","INTERNAL MEDICINE","","1831107341","19610825","307 N PARK AVENUE","SHELLEY","ID","83274","1128b4","20241020","00000000","00000000",""
"CAGER","CRYSTAL","","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19850801","2742 E 83RD STREET, APT 2","CHICAGO","IL","60617","1128a1","20241020","00000000","00000000",""
"CAIN","TANAYE","MARQUISE","","EMPLOYEE - PRIVATE S","ASSISTED LIVING FACI","","0000000000","19880904","18211 LEWIS DRIVE","MAPLE HEIGHTS","OH","44137","1128a3","20241020","00000000","00000000",""
"CALDWELL","KIMBERLY","ANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19610210","114 KAVANAUGHT STREET","TRENTON","MO","64683","1128b4","20241020","00000000","00000000",""
"CANITEZ","MELISSA","RACHEL","","IND- LIC HC SERV PRO","PHARMACIST","","1083205066","19950610","805 CHANDLER STREET","TEWKSBURY","MA","01876","1128b4","20241020","00000000","00000000",""
"CARDENAS","JOSMARY","A","","BUS OWNER/EXEC","PHARMACY","","0000000000","19820730","27 TANNERS ROAD","GREAT NECK","NY","11020","1128a1","20241020","00000000","00000000",""
"CARLOMAGNO","KENT","GENE","","IND- LIC HC SERV PRO","CHIROPRACTIC","","1770768954","19570220","67 WHARF CIRCLE","SAN RAFAEL","CA","94903","1128b4","20241020","00000000","00000000",""
"CARLTON","JON'NAE","","","EMPLOYEE - PRIVATE S","HOME HEALTH AGENCY","","0000000000","20030930","2292 ASHURST RD","CLEVELAND","OH","44118","1128a1","20241020","00000000","00000000",""
"CARTER","CAITLYN","CAROLINE","","IND- LIC HC SERV PRO","SOCIAL WORKER","","0000000000","19980130","2087 LINDA LANE","WILTON","IA","52778","1128a2","20241020","00000000","00000000",""
"CARTER","JESSICA","MAXINE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19850120","29650 SPRING COPPER","BULVERDE","TX","78163","1128b4","20241020","00000000","00000000",""
"CASTANEDA","SABRINA","MARIE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19790515","414 HAMILTON RD","PALESTINE","TX","75801","1128b4","20241020","00000000","00000000",""
"CAUDLE","DANIEL","RYAN","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19870316","12354 DUBUQUE ROAD","OMAHA","AR","72662","1128a1","20241020","00000000","00000000",""
"CAWLEY","APRIL","LYNN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19720224","2019 AUTUMN LANE","TALLAHASSEE","FL","32305","1128b4","20241020","00000000","00000000",""
"CEDRES DUARTE","ERNESTO","","","BUS OWNER/EXEC","DME - GENERAL","","0000000000","19680102","P O BOX 5010","OAKDALE","LA","71463","1128a1","20241020","00000000","00000000",""
"CHAVIS","TOYA","LORETTA","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19911210","6440 HAVERFORD AVENUE","PHILADELPHIA","PA","19151","1128a1","20241020","00000000","00000000",""
"CHOVANEC","KAITLYN","N","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19910502","7641 N SHERMAN BLVD","MILWAUKEE","WI","53208","1128b4","20241020","00000000","00000000",""
"CHUNG","JENNIFER","ANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19850906","4583 SW 128TH PLACE","MIAMI","FL","33175","1128b4","20241020","00000000","00000000",""
"CIGARROA","ASHLEY","CAROLINE","","EMPLOYEE - PRIVATE S","DME - GENERAL","","0000000000","19920828","GLEN RAY ROAD, BOX A","ALDERSON","WV","24910","1128a1","20241020","00000000","00000000",""
"CLARK","ROBERT","MATTHEW","","BUS OWNER/EXEC","LABORATORY","","0000000000","19940401","P O BOX 019120","MIAMI","FL","33101","1128a1","20241020","00000000","00000000",""
"COCHRANE","VANESSA","L","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19791204","118 PILGRIM TRAIL","LIMA","OH","45804","1128a2","20241020","00000000","00000000",""
"COLLAZO","JORGE","BERNADIEL SR","","BUS OWNER/EXEC","DME - GENERAL","","0000000000","19760815","P O BOX 019120","MIAMI","FL","33101","1128a1","20241020","00000000","00000000",""
"COLLINS","MARIAH","LORRAINE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19960805","722 W CHERRY STREET","CHEROKEE","IA","51012","1128b4","20241020","00000000","00000000",""
"COLMER","CECILY","MARIE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19830726","4811 GURLEY AVE","DALLAS","TX","75223","1128b4","20241020","00000000","00000000",""
"CONNER","MELISSA","RENEE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19740310","220 COAL FIELD CAMP ROAD","OLIVER SPRINGS","TN","37840","1128b4","20241020","00000000","00000000",""
"CORBIN","BOOKER","L","","EMPLOYEE - ST/LOC/TR","STATE GOV'T","","0000000000","19930126","3055 N NEW JERSEY ST","INDIANAPOLIS","IN","46205","1128a3","20241020","00000000","00000000",""
"CORNIST","MARKIANA","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1063782282","19881227","6983 DAYBREAK DRIVE","CINCINNATI","OH","45247","1128a1","20241020","00000000","00000000",""
"CRABTREE","HAILY","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19930624","118 BOONVILLE RD","JEFFERSON CITY","MO","65109","1128b4","20241020","00000000","00000000",""
"CRONIN","ROBIN","L","","EMPLOYEE - PRIVATE S","DENTAL PRACTICE","","0000000000","19610907","33 RANKIN STREET","WORCESTER","MA","01605","1128a1","20241020","00000000","00000000",""
"CULLINANE","RILEY","SEAN","","IND- LIC HC SERV PRO","CHIROPRACTIC","","1659763548","19870819","315 N 3RD ST","BRAINERD","MN","56401","1128a2","20241020","00000000","00000000",""
"CURRIE","WILLIAM","ROBERT","","IND- LIC HC SERV PRO","DENTIST","","1093856973","19590816","215 TAVERN BLVD","BOILING SPRINGS","PA","17007","1128b4","20241020","00000000","00000000",""
"CURTY","LISA","","","BUS OWNER/EXEC","MARKETING FIRM","","0000000000","19761227","193 PLEASANT PLAINS AVE","STATEN ISLAND","NY","10309","1128a3","20241020","00000000","00000000",""
"DAVIDHIZAR","LAVERN","RAY","","PHYSICIAN (MD, DO)","GENERAL PRACTICE","","1154334381","19450218","1240 CHINOOK DRIVE","KENAI","AK","99611","1128a4","20241020","00000000","00000000",""
"DAVIDSON","BRUCE","EDWARD","","BUS OWNER/EXEC","MARKETING FIRM","","0000000000","19461219","130 WEST 20TH AVENUE","COVINGTON","LA","70433","1128a1","20241020","00000000","00000000",""
"DAVIS","ASHLYNN","R","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1700174919","19871205","151 BIGELOW DR","JOHNSTOWN","OH","43031","1128a1","20241020","00000000","00000000",""
"DAVIS","HAYLY","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19841101","407 E HUNTING TOWER RUN","MONTGOMERY","TX","77316","1128b4","20241020","00000000","00000000",""
"DAVIS","REBECCA","LYNN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19791017","5225 DEL PAZ DR","COLORADO SPRINGS","CO","80918","1128b4","20241020","00000000","00000000",""
"DEAN","TRACY","L","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19711220","935 EVERGREEN ROAD","WAUSAU","WI","54403","1128b4","20241020","00000000","00000000",""
"DEBOSE","SHEQUITA","ELIZABETH","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19911110","1316 W 11TH STREET","SANFORD","FL","32771","1128a3","20241020","00000000","00000000",""
"DEMOREST","STANLEY","DAVID","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1982769071","19560708","P O BOX 14500","LEXINGTON","KY","40512","1128a1","20241020","00000000","00000000",""
"DENMARK","DANIELLE","RENEE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19740221","P O  BOX 924","NEOSHO","MO","64850","1128b4","20241020","00000000","00000000",""
"DESMARAIS","VERONICA","ELAINE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19840829","5393 NORTHCUTT COVE RD","MCMINNVILLE","TN","37110","1128a4","20241020","00000000","00000000",""
"DHALIWAL","SIMRANPREET","SINGH","","IND- LIC HC SERV PRO","TECHNICIAN","","0000000000","19941129","2045 SAFFRON DRIVE","MANTECA","CA","95337","1128b4","20241020","00000000","00000000",""
"DINH","HANNA","TRINH","","INDIVIDUAL (UNAFFILI","NO KNOWN AFFILIATION","","0000000000","19580619","21661 TWINFORD DR","LAKE FOREST","CA","92630","1128b1","20241020","00000000","00000000",""
"DOWERS","THERESA","MONIER","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19810604","3936 ALABAMA ST, APT 5","SAN DIEGO","CA","92104","1128b4","20241020","00000000","00000000",""
"DREW","KARI","JO","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19750511","1076 E ABRAMS ROAD","BLOOMFIELD","IN","47424","1128a4","20241020","00000000","00000000",""
"DWYER","NORA","J","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19620127","17 CHARLES RIVER ROAD","MEDWAY","MA","02053","1128b4","20241020","00000000","00000000",""
"EBHODAGHE","FAITH","EFEMENA","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19820208","20407 WINDCREST COLONY TRL","RICHMOND","TX","77407","1128b4","20241020","00000000","00000000",""
"EBONG","COMFORT","AUGUSTINE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19651120","9186 W MEADOW DRIVE","PEORIA","AZ","85382","1128b4","20241020","00000000","00000000",""
"ENGESETH","CHRISTOPHER","ALLEN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19730409","405 N TETON DRIVE","BRANDON","SD","57005","1128b4","20241020","00000000","00000000",""
"ESPINOZA","DANIEL","DAVID","","BUS OWNER/EXEC","MARKETING FIRM","","0000000000","19690609","P O BOX 019120","MIAMI","FL","33101","1128a1","20241020","00000000","00000000",""
"EUBANK","HANNAH","DEANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","20000201","405 WASHINGTON AVE, APT A","FRANKFORT","IN","46041","1128a3","20241020","00000000","00000000",""
"EVANS","SUSAN","WILLIAMS","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19640305","918 FERRARA CIRCLE, UNIT A","TEMPLE","TX","76502","1128b4","20241020","00000000","00000000",""
"FIKES","FORREST","BLAKE","","EMPLOYEE - PRIVATE S","MARKETING FIRM","","0000000000","19941209","4800 LEEWARD AVENUE","NORTHPORT","AL","35473","1128a1","20241020","00000000","00000000",""
"FLEIRES","YOANDY","CORREA","","BUS OWNER/EXEC","DME - GENERAL","","0000000000","19830921","1900 SIMLER AVENUE","BIG SPRING","TX","79720","1128a1","20241020","00000000","00000000",""
"FOLKNER","TIFFANY","","","EMPLOYEE - PRIVATE S","MENTAL/BEHAVIORAL HE","","0000000000","19761103","1525 E DUCHESNE DR","FLORISSANT","MO","63031","1128a1","20241020","00000000","00000000",""
"FRANCISCO","ALLISON","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19751215","3175 OLD BAUMGARTNER ROAD","SAINT LOUIS","MO","63129","1128b4","20241020","00000000","00000000",""
"FRANKLIN","ANNMARIE","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19621110","37 OSGOOD STREET","GARDNER","MA","01440","1128b4","20241020","00000000","00000000",""
"FRANKS","TIMOTHY","EDWIN","","IND- LIC HC SERV PRO","THERAPIST","","0000000000","19660912","727 PARK RIDGE CIR","PORT ORANGE","FL","32127","1128b4","20241020","00000000","00000000",""
"FREELS","KAYREN","LYNN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19570518","1390 CALLEJON PALACIOUS, UNIT","CHULA VISTA","CA","91910","1128b4","20241020","00000000","00000000",""
"GAINES","JOSEPH","V","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19461224","5719 REEDLAND STREET","PHILADELPHIA","PA","19143","1128a1","20241020","00000000","00000000",""
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"WEBB","MICHEAL","","","EMPLOYEE - PRIVATE S","INTER CARE FACILITY","","0000000000","19591221","14508 LAKE SHORE BLVD","CLEVELAND","OH","44110","1128a2","20241020","00000000","00000000",""
"WEBER","CALVIN","ADOLPH","","IND- LIC HC SERV PRO","DENTIST","","1841341567","19580218","300 VALLEY STREET","GLENWOOD","IA","51534","1128a2","20241020","00000000","00000000",""
"WEED","JARICA","D","","IND- LIC HC SERV PRO","SOCIAL WORKER","","1689957870","19880417","93 YOUNGTOWN ROAD","LINCOLNVILLE","ME","04849","1128b4","20241020","00000000","00000000",""
"WELLS","JOHN","EDWARD","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19580531","5903 E MARITA ST","LONG BEACH","CA","90815","1128b4","20241020","00000000","00000000",""
"WHITSON","LELAND","GILBERT","","PHYSICIAN (MD, DO)","GYN/OBS","","1063499572","19400612","21345 HAWTHORNE BLVD, UNIT 224","TORRANCE","CA","90503","1128a1","20241020","00000000","00000000",""
"WIGINGTON","MELISSA","ANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19770806","6416 GREENFIELD COURT","FORT WORTH","TX","76148","1128b4","20241020","00000000","00000000",""
"WILEY","ROBIN","RENE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19680530","615 W 5TH STREET","FORT SCOTT","KS","66701","1128b4","20241020","00000000","00000000",""
"WILLIAMS","BOBBY","LEE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19930224","P O BOX 604","HOLBROOK","AZ","86025","1128b4","20241020","00000000","00000000",""
"WILLIAMS","CIERA","LASHARA","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19860805","1024 DRAKE FEATHER DRIVE","ORANGE PARK","FL","32065","1128a4","20241020","00000000","00000000",""
"WILLIAMS","THOMAS","E","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19520908","2723 BENNETT CT","SAINT LOUIS","MO","63139","1128b4","20241020","00000000","00000000",""
"WITHALL","ELISE","VICTORIA","","BUS OWNER/EXEC","BILLING SERVICE CO","","0000000000","19730914","515 PENT STREET","TARPON SPRINGS","FL","34689","1128a1","20241020","00000000","00000000",""
"WRIGHT","AMY","LYN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1437636180","19710411","1024 W LOUISIANA ST","DURANT","OK","74701","1128b4","20241020","00000000","00000000",""
"WRIGHT","KRYSTAL","LEE","","IND- LIC HC SERV PRO","PHARMACY TECHNICIAN","","0000000000","19920328","7711 GREENBACK LN, APT 68","CITRUS HEIGHTS","CA","95610","1128b4","20241020","00000000","00000000",""
"YATES","SARAH","MICHELLE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19810625","602 N WILLOW STREET","COFFEYVILLE","KS","67337","1128b4","20241020","00000000","00000000",""
"YOUNG","MEGAN","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19790225","9602 N 11TH AVENUE, APT 1","PHOENIX","AZ","85021","1128b4","20241020","00000000","00000000",""