LASTNAME,FIRSTNAME,MIDNAME,BUSNAME,GENERAL,SPECIALTY,UPIN,NPI,DOB,ADDRESS,CITY,STATE,ZIP,EXCLTYPE,EXCLDATE,REINDATE,WAIVERDATE,WVRSTATE
,,,AGNES CENTERS FOR DOMESTIC SOL,OTHER BUSINESS,COMM MNTL HLTH CNTR,,1609376698,,"455 S 48TH STREET, STE 106",TEMPE,AZ,85281,1128a1,20250220,0,0,
AGUSTIN,ISAURO,MARABUT JR,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19651004,1300 PASEO DORADO,FULLERTON,CA,92833,1128a1,20250220,0,0,
ASHBY,JILL,LORI,,IND- LIC HC SERV PRO,NURSE PRACTITIONER (,,1609237239,19860926,2212 POST OAK COURT,DENTON,TX,76210,1128a4,20250220,0,0,
BANKSTON,CURTIS,KEITH,,BUS OWNER/EXEC,BOARDING HOME,,0,19660325,102 VALLEY ROAD,GRIFFIN,GA,30224,1128a3,20250220,0,0,
BAYER,CRYSTAL,TANIELE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19751008,1539 BLUE WATER DR,FREEPORT,TX,77541,1128b4,20250220,0,0,
BELL,ANTHONY,DUANE JR,,BUS OWNER/EXEC,DME - GENERAL,,0,19900428,"1200 S FIGUEROA ST, UNIT W914",LOS ANGELES,CA,90015,1128b2,20250220,0,0,
BOND,ASHLEY,VIRGINIA,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19800718,9895 SAND CHERRY WAY,LITTLETON,CO,80129,1128b4,20250220,0,0,
BRUNNER,MICHELLE,AUSTAMARIE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19790722,2161 TEAL CT,PUEBLO,CO,81008,1128b4,20250220,0,0,
BURCIAGA,ARMANDO,,,IND- LIC HC SERV PRO,THERAPIST,,0,19761125,228 YOUMANS DRIVE,VENTURA,CA,93003,1128a4,20250220,0,0,
CAMPION,DONNA,MARIE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19580828,3067 NW 120TH WAY,SUNRISE,FL,33323,1128b4,20250220,0,0,
CANALES,SHERWIN,BOBSON TANGHAL,,BUS OWNER/EXEC,HOSPICE,,0,19820908,"6416 ORANGE AVE, APT 39",CYPRESS,CA,90630,1128a1,20250220,0,0,
CASTANEDA,MARIA,ROSARIO,,BUS OWNER/EXEC,HOSPICE,,0,19740614,13063 CLAREMORE STREET,VICTORVILLE,CA,92392,1128a1,20250220,0,0,
CHACKO,JISHA,CHERIAN,,IND- LIC HC SERV PRO,NURSE PRACTITIONER (,,1073804944,19770821,1261 MCMAHAN DRIVE,LEWISVILLE,TX,75077,1128a4,20250220,0,0,
CHRISTOPHEL,CONSTANCE,LYNN,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19600917,12268 DEEP CREEK DRIVE,SPRING HILL,FL,34609,1128b4,20250220,0,0,
CLARE,STEPHEN,MICHAEL,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,1730493206,19720601,1507 HASKIN DR,SAN ANTONIO,TX,78209,1128b4,20250220,0,0,
COLE,MARCUS,AARON,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19860801,51662 COUNTY ROAD 27,NUNN,CO,80648,1128b4,20250220,0,0,
COUTEE,HUNTER,BAILEE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,20000614,1121 KIMBERLY DRIVE,SHREVEPORT,LA,71118,1128a2,20250220,0,0,
DIKE,ARINZE,SAMPSON JR,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19851119,1013 E KINKAID ST,WICHITA,KS,67211,1128b4,20250220,0,0,
DILLION,JOBIE,LEE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19730914,34041 VALENCIA DR,LEESBURG,FL,34788,1128b4,20250220,0,0,
DODSON,ASHLIE,BROOKE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19790920,841 RS COUNTY ROAD 2350,EMORY,TX,75440,1128a4,20250220,0,0,
DRENNAN,FREDDY,RAY III,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19880304,812 CAMERON DR,WINDSOR,CO,80550,1128b4,20250220,0,0,
DUNKERLEY,THOMAS,EDWARD,,EMPLOYEE - ST/LOC/TR,STATE GOV'T,,0,19560427,902 W LYNWOOD ST,PHOENIX,AZ,85007,1128b1,20250220,0,0,
DUPUIS,AUDRIANNA,MARIE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19910126,112 HILLTOP ROAD,BILLINGS,MT,59105,1128b4,20250220,0,0,
ENSTAD,BRITTANY,A,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19831229,27203 LOVELY PLACE,TEA,SD,57064,1128a4,20250220,0,0,
EWING,TERRENCE,,,BUS OWNER/EXEC,COMM MNTL HLTH CNTR,,0,19620319,"455 E OHIO STREET, APT 4009",CHICAGO,IL,60611,1128a1,20250220,0,0,
FACHINI,ANTHONY,CHRISTOPHER,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19931025,43800 E 88TH AVE,BENNETT,CO,80102,1128b4,20250220,0,0,
FEWINS,JOHN,KEVIN,,INDIVIDUAL (UNAFFILI,PERSONAL CARE PROVID,,0,19660728,"217 N WASHINGTON AVE, APT 213",IOLA,KS,66749,1128a1,20250220,0,0,
FIELDS,GLENDA,RENA,,EMPLOYEE - PRIVATE S,HOME HEALTH AGENCY,,0,19831019,4955 TIPPECANOE DRIVE,EVANSVILLE,IN,47715,1128a2,20250220,0,0,
FISHER,CORA,LEA,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,1578814299,19740724,137 S ASH STREET,FRUITA,CO,81521,1128b4,20250220,0,0,
FOFFOU,GUIDE,MBOU,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19750227,"21540 PROVINCIAL BLVD, APT 232",KATY,TX,77450,1128b4,20250220,0,0,
FOX,SHAYLA,ANN,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19880430,506 E OAK ST,LAMAR,CO,81052,1128b4,20250220,0,0,
GAVINA,MARIE,GRACE GUTANG,,OWNER/EXEC-GOVT CONT,MEDICAID MANAGED CAR,,0,19760922,2395 S TAPESTRY WAY,ANAHEIM,CA,92802,1128a1,20250220,0,0,
GEALOGO,RANDY,PRUDENCIO,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19791110,1240 N VENTURA STREET,ANAHEIM,CA,92801,1128a1,20250220,0,0,
GOBER,JEREMY,ROBERT,,EMPLOYEE - PRIVATE S,CLINIC,,0,19800803,P O BOX 1000,DULUTH,MN,55814,1128a1,20250220,0,0,
GOBER,TRAVIS,CHRISTIAN,,BUS OWNER/EXEC,CLINIC,,0,19781113,1306 ELAINE DRIVE,HANFORD,CA,93230,1128a1,20250220,0,0,
GOODWIN,KRISTOFER,DEJUAN,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19910320,104 RANDOLPH STREET,SEMINOLE,OK,74868,1128a2,20250220,0,0,
GRAHAM,MARY,ELIZABETH,,IND- LIC HC SERV PRO,SOCIAL WORKER,,1528617164,19801019,2906 A GRADY ROAD,TALLAHASSEE,FL,32312,1128b4,20250220,0,0,
GREENE,PHILLIP,JEFFREY,,"PHYSICIAN (MD, DO)",SURGERY,,1346248481,19650116,7038 LASORDA LANE,EDWARDSVILLE,IL,62025,1128a1,20250220,0,0,
GREWAL,NAVANJUN,SINGH,,"PHYSICIAN (MD, DO)",PLASTIC SURGERY,,1477743094,19780902,"248 S DOHENY DR, UNIT 4",BEVERLY HILLS,CA,90211,1128a3,20250220,0,0,
GRIJALVA,JAMIE,DENISE,,EMPLOYEE - PRIVATE S,CLINIC,,0,19690903,1072 8TH ST,ASTORIA,OR,97103,1128a4,20250220,0,0,
GROVOGEL,MIRANDA,KATHLEEN,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19801013,"2745 N FANCHER ROAD, APT 102",RACINE,WI,53406,1128b4,20250220,0,0,
GUTIERREZ,PAUL,EDMUND JR,,IND- LIC HC SERV PRO,COUNSELOR,,1942606777,19611128,6420 PEERLESS FARM RD,PEYTON,CO,80831,1128b4,20250220,0,0,
HARRELL,CIERA,DANIELLE,,EMPLOYEE - PRIVATE S,MENTAL/BEHAVIORAL HE,,1265807036,19900903,26104 WILLOW WOOD ST,DENHAM SPRINGS,LA,70726,1128a1,20250220,0,0,
HARRISON,MISSIBI,NGEAH,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19880317,381 MAIN STREET,WEST TOWNSEND,MA,1474,1128b4,20250220,0,0,
HAYGOOD,KENNETH,DONALD,,"PHYSICIAN (MD, DO)",FAMILY PRACTICE,,1326046616,19690502,"2830 S HULEN ST, BOX 809",FORT WORTH,TX,76109,1128b4,20250220,0,0,
HEMPEL,CARLI,ADELE,,EMPLOYEE - PRIVATE S,CLINIC,,0,19761119,"705 W AVENUE B, APT 2315",GARLAND,TX,75040,1128a3,20250220,0,0,
HEUBY,KAMIE,LEE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19671027,8070 E COUNTY ROAD 125 S,DUGGER,IN,47848,1128a3,20250220,0,0,
JOHNSON,MARY,ELIZABETH,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19750407,1006 MARBLERIDGE DRIVE,ORANGE PARK,FL,32065,1128b4,20250220,0,0,
KNIGHTON,LEIA,RAE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19771005,21611 FLOWERING CRAB APPLE DRI,PORTER,TX,77365,1128b4,20250220,0,0,
KOLB,RICHARD,GRANT,,INDIVIDUAL (UNAFFILI,NO KNOWN AFFILIATION,,0,19770911,3153 JUANITA AVENUE,GILBERT,AZ,85234,1128a3,20250220,0,0,
LAND,LORRAINE,ANNE,,IND- LIC HC SERV PRO,COUNSELOR,,1174784193,19721001,27 ROSE HILL DRIVE,BEAR,DE,19701,1128b4,20250220,0,0,
LEE,GRETCHEN,NANETTE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19700805,"6937 S TRENTON AVENUE, APT 713",TULSA,OK,74136,1128a2,20250220,0,0,
LEWIS,BRADLEY,DONTE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19870608,"2321 CHAMPA STREET, APT 310",DENVER,CO,80205,1128b4,20250220,0,0,
LUNDE,KATHY,LYNN,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19500602,"432 MADERA AVENUE, APT 4",SUNNYVALE,CA,94086,1128a2,20250220,0,0,
MANN,ERYN,SUE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19841117,"168 N AUTUMN LANE, APT 2",PETERSBURG,IN,47567,1128b4,20250220,0,0,
MCCARTHY,DENNIS,STANLEY,,IND- LIC HC SERV PRO,THERAPIST,,0,19691103,616 MANOR PLACE,MELBOURNE,FL,32904,1128b4,20250220,0,0,
MCCONNELL,RODRICK,,,EMPLOYEE - PRIVATE S,PERSONAL CARE PROVID,,0,19770509,21318 FOUR OAKS DR,HOUSTON,TX,77073,1128a1,20250220,0,0,
MCFARLIN,KELLY,JON JR,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19911001,P O BOX 3535,NORCO,CA,92860,1128a2,20250220,0,0,
MCMULLIN,JEREMY,LENEAR,,EMPLOYEE - PRIVATE S,ALLIED HEALTH RELATE,,0,19840728,"605 SOUTHWEST COOMBS ROAD,",LAWTON,OK,73501,1128a2,20250220,0,0,
MILES,JOHN,D ROBERT,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19900510,5035 BAYOU GULCH ST,PARKER,CO,80134,1128b4,20250220,0,0,
MILLER,ANGELA,KAY,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19770609,16044 W 13TH PL,GOLDEN,CO,80401,1128b4,20250220,0,0,
MILLER,RANDY,DALE,,INDIVIDUAL (UNAFFILI,PERSONAL CARE PROVID,,0,19600520,3302 RIVERVIEW DR,TWO RIVERS,WI,54241,1128a1,20250220,0,0,
MIRALLES,MORGAN,,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19910129,2615 11TH ST,SIOUX CITY,IA,51105,1128a4,20250220,0,0,
MITCHELL,APRIL,LYNN,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19811108,"620 MERLIN DRIVE, UNIT 103",LAFAYETTE,CO,80026,1128b4,20250220,0,0,
MUNROE,MARTIN,ALLEN,,IND- LIC HC SERV PRO,THERAPIST,,0,19761025,719 PEAR STREET,LAKELAND,FL,33815,1128b4,20250220,0,0,
NADREAU,PETRUS,EDDY,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19681123,850 SW 16TH TERRACE,CAPE CORAL,FL,33991,1128b4,20250220,0,0,
NICHOLS,CHEYENNE,BRENAE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,20020131,"12404 NW MILLER ROAD, APT E",BRISTOL,FL,32321,1128b4,20250220,0,0,
NORWOOD,CHARMAYNE,,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19790911,4422 RALSTON  AVE,INDIANAPOLIS,IN,46205,1128a4,20250220,0,0,
OTTO,ERICKA,LYNNE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19881003,"11420 DESTINATION DRIVE, APT 3",BROOMFIELD,CO,80021,1128b4,20250220,0,0,
PAYNE,BRITTNEY,GEORGETTE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19901213,"2404 WINCHESTER STREET, APT L",BALTIMORE,MD,21216,1128a3,20250220,0,0,
RAMSKI,NEIL,S,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19551219,1236 LECHLADE STREET,JACKSONVILLE,FL,32205,1128b4,20250220,0,0,
RILEY,LEONA,,,EMPLOYEE - ST/LOC/TR,STATE GOV'T,,0,19991118,3673 MONROE STREET,GARY,IN,46408,1128a2,20250220,0,0,
RISEDORF,MICHAEL,DAVID,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19620302,3833 S NELSON CT,DENVER,CO,80235,1128b4,20250220,0,0,
RIVERA,EDGARDO,JOEL,,IND- LIC HC SERV PRO,PHARMACY TECHNICIAN,,0,19940126,"806 RAVENS CIRCLE, APT 106",ALTAMONTE SPRINGS,FL,32714,1128b4,20250220,0,0,
ROBINSON,DANNY,KAYE II,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19651014,7319 S PR 425 W,SHELBYVILLE,IN,46176,1128a2,20250220,0,0,
ROSENBARGER,ROBERT,ALEXANDER,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19890609,1285 HIGH ST,CHARLESTOWN,IN,47111,1128a4,20250220,0,0,
SANDEFUR,ERIC,TODD,,"PHYSICIAN (MD, DO)",ORTHOPEDICS,,1346333721,19650311,838 POETS CORNER WAY,KNOXVILLE,TN,37919,1128b4,20250220,0,0,
SAUNDERS,TARA,DANIELLE,,INDIVIDUAL (UNAFFILI,PERSONAL CARE PROVID,,0,19800815,"3224 HIGHWAY 20, UNIT 5",SWEET HOME,OR,97386,1128a2,20250220,0,0,
SCHLOTTERBECK,LARA,CAROL,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19690726,"2027 COLLEGE AVE, APT 2",VINCENNES,IN,47591,1128a4,20250220,0,0,
SCOLA,JERE,ANTHONY III,,IND- LIC HC SERV PRO,PODIATRY,,1649201153,19711228,185 SUMMER STREET,KENNEBUNK,ME,4043,1128b4,20250220,0,0,
SHELTON,FALANDA,LEE,,EMPLOYEE - PRIVATE S,DME - GENERAL,,1558855973,19770304,2113 HANFRED COURT,TUCKER,GA,30084,1128b7,20241231,0,0,
SISON,RAULITO,DE LUNA,,INDIVIDUAL (UNAFFILI,RECRUITER/CAPPER,,0,19651015,1028 MARINE AVE APT 233,GARDENA,CA,90247,1128a1,20250220,0,0,
STOWE,SHELBE,ELIZAEBETH,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19951230,2335 CARMEL DRIVE,COLORADO SPRINGS,CO,80910,1128b4,20250220,0,0,
TAIWO,BRESHAWNE,FOLASADE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19990903,"13950 E OXFORD PLACE, APT B101",AURORA,CO,80014,1128b4,20250220,0,0,
TAMBRE,JESSICA,JOLIE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19700623,960 E 3RD AVENUE,DURANGO,CO,81301,1128b4,20250220,0,0,
TENNEY,LAUREN,NICOLE,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19940316,4350 E JOHNSON AVE,PENSACOLA,FL,32514,1128b4,20250220,0,0,
TORRES,ELIA,ENID,,IND- LIC HC SERV PRO,THERAPIST,,1831417567,19800111,"194 HALPINE ROAD, APT 2101",ROCKVILLE,MD,20852,1128a1,20250220,0,0,
TOWNSEND,SUSAN,ANN,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19770531,304 N 13TH STREET,LAMAR,CO,81052,1128b4,20250220,0,0,
VEGA,ANTONIA,,,IND- LIC HC SERV PRO,PHARMACY TECHNICIAN,,0,19880106,P O BOX 1731,WASECA,MN,56093,1128a4,20250220,0,0,
WELCH,ANDREW,JACKSON III,,"PHYSICIAN (MD, DO)",SURGERY,,1518907435,19441123,37 GULF STREAM COURT,LAS VEGAS,NV,89113,1128b4,20250220,0,0,
"WHITE, II",ARNOLD,L,,IND- LIC HC SERV PRO,NURSE/NURSES AIDE,,0,19921015,1009 TATE STREET,WARREN,AR,71671,1128a2,20250220,0,0,
WINSTON,MILISSA,BAUGH,,IND- LIC HC SERV PRO,COUNSELOR,,1619348885,19661118,12820 S BLACKFOOT DRIVE,OLATHE,KS,66062,1128a1,20250220,0,0,