LASTNAME,FIRSTNAME,MIDNAME,BUSNAME,GENERAL,SPECIALTY,UPIN,NPI,DOB,ADDRESS,CITY,STATE,ZIP,EXCLTYPE,EXCLDATE,REINDATE,WAIVERDATE,WVRSTATE
"","","","PRO MED ALLIANCE MEDICAL STAFF","OTHER BUSINESS","MANAGEMENT SVCS CO","","1790248557","","4905 SW 319TH LN, APT D204","FEDERAL WAY","WA","98023","1128a1","20250918","00000000","00000000",""
"ABBINETT","SANDRA","K","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19800319","718 E GEORGIA STREET, APT 121","INDIANAPOLIS","IN","46202","1128a4","20250918","00000000","00000000",""
"ADIBI","JUSTIN","SAAM","","PHYSICIAN (MD, DO)","SURGERY","","1063073757","19900802","153A BRADFORD COURT","MOUNT LAUREL","NJ","08054","1128b4","20250918","00000000","00000000",""
"ALLEN","ASHLEY","KATHLEEN","","IND- LIC HC SERV PRO","SOCIAL WORKER","","1063012722","19920530","10 FAIRWAY LANE, APT 1","LOGAN","UT","84321","1128b4","20250918","00000000","00000000",""
"ALLIS","ROBIN","LEE","","IND- LIC HC SERV PRO","SOCIAL WORKER","","1356464507","19620429","314 CLAIR ROAD","WYALUSING","PA","18853","1128b4","20250918","00000000","00000000",""
"ANACREON","BETTY","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19730706","3024 N POWERS DRIVE, APT 169","ORLANDO","FL","32818","1128b4","20250918","00000000","00000000",""
"BAKER","MARY ANN","HUGGINS","","EMPLOYEE - PRIVATE S","ASSISTED LIVING FACI","","0000000000","19641129","1530 NAVAHO AVE","JACKSONVILLE","FL","32210","1128a2","20250918","00000000","00000000",""
"BARKLEY","BONITA","LAFAYE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1427535871","19780629","3500 WINDMEADOWS BLVD, APT 41","GAINESVILLE","FL","32608","1128b4","20250918","00000000","00000000",""
"BARRINGTON","CLARICE","SHANTELLE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19760108","6451 CRESCENT WAY, APT 203","NORFOLK","VA","23513","1128b4","20250918","00000000","00000000",""
"BELL","JUSTIN","TYLER","","IND- LIC HC SERV PRO","PHARMACIST","","1780225839","19841012","P O BOX 4000","MANCHESTER","KY","40962","1128a1","20250918","00000000","00000000",""
"BERRY","JOANN","SCYPHERS","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19681115","25099 CAVE CREEK ROAD","ABINGDON","VA","24211","1128b4","20250918","00000000","00000000",""
"BLAIR","MICHAEL","EVAN","","IND- LIC HC SERV PRO","THERAPIST","","1063625481","19490618","805 S DIXIE DRIVE, UNIT 42","SAINT GEORGE","UT","84770","1128a1","20250918","00000000","00000000",""
"BRICE","REGINA","RESCHELLE","","BUS OWNER/EXEC","MENTAL/BEHAVIORAL HE","","1326445917","19650424","6978 FOGGY MIST AVENUE","LAS VEGAS","NV","89179","1128a1","20250918","00000000","00000000",""
"BRIGGS","JENNIFER","D","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19700714","P O BOX 22","INDEPENDENCE","LA","70443","1128b4","20250918","00000000","00000000",""
"BROWER","RAHNI","REXANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19830710","221 W 15TH ST","CARROLL","IA","51401","1128a4","20250918","00000000","00000000",""
"BROWN","STEPHANIE","ELIZABETH","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19781003","2919 SHILOH CHURCH ROAD","MIDLOTHIAN","VA","23112","1128b4","20250918","00000000","00000000",""
"BURKHART","ROBIN","RENEE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19721011","4219 S MARTIN ROAD","CARBON","IN","47837","1128a2","20250918","00000000","00000000",""
"BYRD NEWMAN","KNORCIA","","","IND- LIC HC SERV PRO","PHARMACIST","","1508832882","19790430","1050 DRAKE FEATHER DRIVE","ORANGE PARK","FL","32065","1128b4","20250918","00000000","00000000",""
"CAMARDA","PAUL","JOSEPH","","EMPLOYEE - PRIVATE S","DRUG COMPANY/SUPLIER","","0000000000","19820121","45 BLACKHAWK CT","HOLMDEL","NJ","07733","1128a3","20250918","00000000","00000000",""
"CANTRELL","CAROL","R","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1417996117","19530615","200 N OAK ST","SPRINGFIELD","TN","37172","1128b4","20250918","00000000","00000000",""
"CASTRO","DAN","JOSHUA III","","PHYSICIAN (MD, DO)","OTORHINOLARYNGOLOGY","","1457301293","19510527","P O BOX 34550","MEMPHIS","TN","38184","1128a3","20250918","00000000","00000000",""
"CHASE","MICHELLE","","","EMPLOYEE - PRIVATE S","HOME HEALTH AGENCY","","0000000000","19700225","4225 CEDARTREE DRIVE","MEMPHIS","TN","38141","1128a1","20250918","00000000","00000000",""
"CHEN","HUMPHREY","","","IND- LIC HC SERV PRO","THERAPIST","","0000000000","19711109","1389 BROOK LANE","JAMISON","PA","18929","1128b4","20250918","00000000","00000000",""
"CLARK","ROCQUEL","SHEILA","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19880921","2662 QUAIL RIDGE AVENUE","PERU","IA","50222","1128a3","20250918","00000000","00000000",""
"CLARK","TINA","MARIE","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","1982397410","19810308","278 S LOCUST AVE","WHITE CLOUD","MI","49349","1128a1","20250918","00000000","00000000",""
"DAVIS","MORGAN","MARIE","","EMPLOYEE - PRIVATE S","ADULT HOME","","0000000000","20050411","1405 13TH STREET","CORALVILLE","IA","52241","1128a3","20250918","00000000","00000000",""
"DAZA ESTUPINAN","LUZ","ANGELA","","EMPLOYEE - PRIVATE S","TRANSPORTATION CO","","0000000000","19711221","5012 KNIGHTSBRIDGE CIR, N","JACKSONVILLE","FL","32244","1128a1","20250918","00000000","00000000",""
"DEDMON","CHARLOTTE","MARIE","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19760221","301 WHITE BLOSSOM CIRCLE","BRYANT","AR","72022","1128a1","20250918","00000000","00000000",""
"DEJARNETTE","DESERAYE","NICOLE","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19950318","8421 HEYDEN ST","DETROIT","MI","48228","1128a1","20250918","00000000","00000000",""
"DRISKILL","TONYA","HILLER","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19670414","6600 RIVER RD","SOUTH CHESTERFIELD","VA","23803","1128b4","20250918","00000000","00000000",""
"EBONKA","FESTUS","ONYEMALIOSIA","","IND- LIC HC SERV PRO","NURSE PRACTITIONER (","","1932241007","19600609","9416 LEADBRICK STREET","LAS VEGAS","NV","89143","1128a1","20250918","00000000","00000000",""
"EISENHART","RACHAEL","MELODY","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19880105","10295 DYKE RD","STANARDSVILLE","VA","22973","1128b4","20250918","00000000","00000000",""
"EMIGH-ROBLES","MARC","FORREST","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19890119","50 JONES STREET, APT 811","SAN FRANCISCO","CA","94102","1128b4","20250918","00000000","00000000",""
"EPPS","THELMA","WENDY","","IND- LIC HC SERV PRO","COUNSELOR","","1649574799","19641110","ROUTE 37","DANBURY","CT","06811","1128a1","20250918","00000000","00000000",""
"ERDBERG","DANIELLE","E","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19871020","4114 SAND LAKE COURT","TAMPA","FL","33624","1128a4","20250918","00000000","00000000",""
"FAIRBANKS","AMY","J","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19700311","531 EXCHANGE ST","ALDEN","NY","14004","1128b4","20250918","00000000","00000000",""
"FAKES","MISTY","D","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19810925","1706 DOGWOOD COURT","HUNTINGBURG","IN","47542","1128a4","20250918","00000000","00000000",""
"FOX","MEREDITH","ROBINSON","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19870717","528 PARK CREST COVE","CHELSEA","AL","00000","1128b4","20250918","00000000","00000000",""
"GILLEY","ANDREA","DION","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19781008","356  WEST WHATLEY ROAD","OAKDALE","LA","71463","1128b4","20250918","00000000","00000000",""
"GONZALEZ MALDONADO","JOSE","A","","INDIVIDUAL (UNAFFILI","NO KNOWN AFFILIATION","","0000000000","19620116","1134 CALLE 9","SAN JUAN","PR","00927","1128a3","20250918","00000000","00000000",""
"GRAY WALLACE","KHAAFI","JAMEEL","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19980104","1709 N EDGEWOOD ST","PHILADELPHIA","PA","19151","1128a1","20250918","00000000","00000000",""
"GUNDERSEN","ANNA","KIRSTINE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19801013","48921 DENTON ROAD, APT 305","BELLEVILLE","MI","48111","1128b4","20250918","00000000","00000000",""
"HALE","SHELI","JEAN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19700703","7149 ELLERSON MILL CIRCLE, APT","MECHANICSVILLE","VA","23111","1128b4","20250918","00000000","00000000",""
"HAMMARQUIST","ADAM","LARS","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19691218","806 SPECTRUM LOOP","COLORADO SPRINGS","CO","80921","1128b4","20250918","00000000","00000000",""
"HANSON","JUSTIN","","","OWNER/EXEC-GOVT CONT","MEDICAID MANAGED CAR","","0000000000","19830202","P O BOX 1002","THOMSON","IL","61285","1128a1","20250918","00000000","00000000",""
"HEISEL","GREGORY","WILLIAM","","IND- LIC HC SERV PRO","PHYSICAL THERAPY","","1215383914","19780830","423 7TH ST","CHETEK","WI","54728","1128b4","20250918","00000000","00000000",""
"HUFF","JENIFER","LOREE","","INDIVIDUAL (UNAFFILI","NO KNOWN AFFILIATION","","0000000000","19781204","P O BOX 7007","MARIANNA","FL","32447","1128a1","20250918","00000000","00000000",""
"IRVINE","DAN","ROBERT","","EMPLOYEE - PRIVATE S","DRUG COMPANY/SUPLIER","","0000000000","19691027","9 BRIDGEWATERS DRIVE, APT 18","OCEANPORT","NJ","07757","1128a3","20250918","00000000","00000000",""
"ISIDRO MARTINEZ","ALEJANDRO","A","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19910705","3100 S FEDERAL BLVD,  APT 311","DENVER","CO","80236","1128b4","20250918","00000000","00000000",""
"ISKANDAROVA","NIGINA","","","BUS OWNER/EXEC","TRANSPORTATION CO","","0000000000","19640922","16 LINKS COURT","MONROE","NY","10950","1128a1","20250918","00000000","00000000",""
"JOHNSON","FELICIA","MARIE","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19890208","1800 N 19TH ST","PARAGOULD","AR","72450","1128a1","20250918","00000000","00000000",""
"JOLLY","BRANT","ALAN","","BUS OWNER/EXEC","LAB - CLINICAL","","0000000000","19970828","538 N SALEM ROAD","FAYETTEVILLE","AR","72704","1128b7","20250709","00000000","00000000",""
"JONES","ALEXANDRIA","NICOLE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19930306","3016 SWANNS INN CRESCENT","GOOCHLAND","VA","23063","1128b4","20250918","00000000","00000000",""
"KARLEWICZ","ERIC","LEE","","BUS OWNER/EXEC","DME - TELEMARKETING","","0000000000","19790326","P O BOX 1000","OTISVILLE","NY","10963","1128a1","20250918","00000000","00000000",""
"KARNES","DENNIS","WILLIAM","","BUS OWNER/EXEC","DME - GENERAL","","0000000000","19680421","P O BOX 019001","ATWATER","CA","95301","1128a1","20250918","00000000","00000000",""
"KOEHLER","REBECA","EILEEN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19830430","4360 129TH AVE N","WEST PALM BEACH","FL","33411","1128b4","20250918","00000000","00000000",""
"KOLLUR","VENKATA","RAMANA MURTHY","","IND- LIC HC SERV PRO","PHARMACIST","","1669035085","19680720","7193 PRIMROSE LANE","GRAND BLANC","MI","48439","1128b4","20250918","00000000","00000000",""
"LEE","KEVIN","CHARLES","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1376001925","19820722","195 N 173RD AVENE, APT 238","GOODYEAR","AZ","85338","1128b4","20250918","00000000","00000000",""
"LEIZGOLD","SHIMON","","","BUS OWNER/EXEC","DENTAL PRACTICE","","0000000000","19750706","14000 NW 41ST STREET","MIAMI","FL","33178","1128a1","20250918","00000000","00000000",""
"LEPAK","ANGELA","RENAE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1871360743","19760315","711B ARLINGTON TERRACE","HAMPTON","VA","23666","1128b4","20250918","00000000","00000000",""
"LEVINSON","DIANE","CHIN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19620606","1905 SPYGLASS DRIVE","SAN BRUNO","CA","94066","1128b4","20250918","00000000","00000000",""
"LINDSEY","IAN","J","","IND- LIC HC SERV PRO","NURSE PRACTITIONER (","","1578936076","19820625","4613 BRECKEN ROAD","MINERAL POINT","WI","53565","1128a1","20250918","00000000","00000000",""
"LINEROS ORJUELA","ASTRID","VIVIANA","","EMPLOYEE - PRIVATE S","TRANSPORTATION CO","","0000000000","19890315","804 CAMERON OAKS PLACE","MIDDLEBURG","FL","32068","1128a1","20250918","00000000","00000000",""
"MALAKHOV","DMYTRO","","","OWNER/EXEC-GOVT CONT","MEDICAID MANAGED CAR","","0000000000","19861210","11815  GILMONE ST, APT 211","NORTH HOLLYWOOD","CA","91606","1128a1","20250918","00000000","00000000",""
"MANNING","JOHN","RICHARD JR","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1356311831","19610121","P O BOX 3000","PINE KNOT","KY","42635","1128a1","20250918","00000000","00000000",""
"MANSOUR","PAUL","","","IND- LIC HC SERV PRO","PHARMACIST","","0000000000","19671201","P O BOX 323","SAN PEDRO","CA","90733","1128a1","20250918","00000000","00000000",""
"MENDEZ","FERNANDO","","","IND- LIC HC SERV PRO","PHYSICIAN ASSISTANT","","1689084675","19730425","5948 FRIARS COURT","BROWNSVILLE","TX","78526","1128a1","20250918","00000000","00000000",""
"MENTOURI","TAREK","ISAAK","","IND- LIC HC SERV PRO","THERAPIST","","0000000000","19880208","515 BEDFORT DRIVE","DULUTH","GA","30096","1128a2","20250918","00000000","00000000",""
"MERCADO","LUISA","EUGENIA","","EMPLOYEE - PRIVATE S","CLINIC","","0000000000","19790211","501 W HIGHWAY 66","KINGMAN","AZ","86401","1128a4","20250918","00000000","00000000",""
"MORDEN","KELLY","CHRISTINE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1558006916","19910215","19880 FORT STREET, APT 203","RIVERVIEW","MI","48193","1128b4","20250918","00000000","00000000",""
"MUMLEY","DAVID","JAY","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19921219","4984 WILLIAMSTOWN BLVD","LAKELAND","FL","33810","1128a1","20250918","00000000","00000000",""
"NASH","JENNIFER","","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","1609948793","19691130","621 ASTER LANE","RIVERVALE","NJ","07675","1128a3","20250918","00000000","00000000",""
"NAVARRO","LOURDES","VILLARBA","","BUS OWNER/EXEC","LAB - CLINICAL","","0000000000","19590126","P O BOX 3725","ADELANTO","CA","92301","1128a1","20250918","00000000","00000000",""
"NESTI","ANGELA","LYNN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19750604","12177 GLASGOW COURT","PARKER","CO","80134","1128b4","20250918","00000000","00000000",""
"NJUME-TATSING","SALLY","","","BUS OWNER/EXEC","HOME HEALTH AGENCY","","1780763102","19770705","P O BOX 3725","ADELANTO","CA","92301","1128a1","20250918","00000000","00000000",""
"O'HARA","MAJEL","ALLEEN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19720126","401 HAWTHORNE COURT","INDIAN HARBOUR BEACH","FL","32937","1128b4","20250918","00000000","00000000",""
"OWENS","KERRY","ANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19840518","1212 BUTTE RD, LOT 50","LOVELAND","CO","80537","1128b4","20250918","00000000","00000000",""
"PARKER","SHAVON","NAOMI","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19850823","1941 GEORGIAN RD","PHILADELPHIA","PA","19138","1128a1","20250918","00000000","00000000",""
"PATEL","MANISHKUMAR","","","BUS OWNER/EXEC","DME - GENERAL","","0000000000","19790714","483 MURRAY STREET","PELHAM","NY","10803","1128a1","20250918","00000000","00000000",""
"PATTON","MARY","ANN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19870118","179 S ENSENADA DR","PUEBLO","CO","81007","1128a2","20250918","00000000","00000000",""
"PIPER","SCOTT","JAMES","","PHYSICIAN (MD, DO)","FAMILY PRACTICE","","1194712976","19711101","555 CHESTNUT DR","ROBINS","IA","52328","1128a2","20250918","00000000","00000000",""
"QUACH","CHARLES","MENG","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19601008","5722 NE 130TH PL","VANCOUVER","WA","98682","1128a1","20250918","00000000","00000000",""
"RIVERA PEREZ","JORGE","","","EMPLOYEE - PRIVATE S","HOSPITAL","","0000000000","19610611","D15 URB JESUS MARIA LAGO","UTUADO","PR","00641","1128a3","20250918","00000000","00000000",""
"ROBINSON","CAMISHA","LASHAY","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","20000707","3601 DEE STREET, APT 1609","SHREVEPORT","LA","71105","1128a1","20250918","00000000","00000000",""
"SANCHEZ BUITRAGO","OMAR","ANDRES","","EMPLOYEE - PRIVATE S","TRANSPORTATION CO","","1366226813","19850430","4285 REFLECTIONS BLVD, APT 101","FORT LAUDERDALE","FL","33351","1128a1","20250918","00000000","00000000",""
"SANDERS","KORY","DANYELLE","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","1730754748","19980211","P O BOX 1352","CHAPMANVILLE","WV","25508","1128a1","20250918","00000000","00000000",""
"SIERRA BERNAL","LUIS","ALBERTO","","EMPLOYEE - PRIVATE S","TRANSPORTATION CO","","0000000000","19680817","5012 KNIGHTSBRIDGE CIR N","JACKSONVILLE","FL","32244","1128a1","20250918","00000000","00000000",""
"SMITH","GWENDLYN","DENISE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19650525","408 W BALDRIDGE STREET","ENNIS","TX","75119","1128a1","20250918","00000000","00000000",""
"SMITH","LATEENA","R","","IND- LIC HC SERV PRO","PSYCHOLOGY","","1326569963","19860411","P O BOX 3066","DECATUR","IL","62524","1128a1","20250918","00000000","00000000",""
"SPENCER","JENNIFER","LYNN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19811025","311 E NATIONAL STREET","VERMILLION","SD","57069","1128a3","20250918","00000000","00000000",""
"SPRADLIN","ROBYN","LYN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19860218","315 MYRES STREET","CROTHERSVILLE","IN","47229","1128a4","20250918","00000000","00000000",""
"STAFFORD","KIARA","M","","EMPLOYEE - PRIVATE S","ASSISTED LIVING FACI","","0000000000","19970415","1052 CUMBERLAND TRL","OSHKOSH","WI","54904","1128a2","20250918","00000000","00000000",""
"STARLING","LATESHIA","SHERISE","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19691201","103 PERIDOT COURT","HERCULES","CA","94547","1128a2","20250918","00000000","00000000",""
"STRUHAR","JESSICA","JUNE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19971219","50338 OAKVIEW DR","CHESTERFIELD","MI","48047","1128a2","20250918","00000000","00000000",""
"STURGEON","MICHELLE","A","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19750723","808 VASSER DRIVE","HATFIELD","PA","19440","1128a4","20250918","00000000","00000000",""
"SUCHOMEL","JOHN","ROBERT","","PHYSICIAN (MD, DO)","OPHTHALMOLOGY","","1801955851","19541225","220 N WING ST","NORTHVILLE","MI","48167","1128b4","20250918","00000000","00000000",""
"TENNART","LEONARD","DARNELL","","IND- LIC HC SERV PRO","COUNSELOR","","1083031488","19640208","11833 GOODWOOD BLVD","BATON ROUGE","LA","70815","1128a1","20250918","00000000","00000000",""
"THOMAS","THURMON","ELDON","","IND- LIC HC SERV PRO","THERAPIST","","1942739115","19790706","1997 W 250 S","HURRICANE","UT","84737","1128b4","20250918","00000000","00000000",""
"TORRES ORTIZ","JULIA","E","","PHYSICIAN (MD, DO)","INTERNAL MEDICINE","","1972814416","19550504","1403 CALLE ALOA","PONCE","PR","00717","1128a1","20250918","00000000","00000000",""
"TRUJILLO-SANDOVAL","DAISY","","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","1124672324","19910503","12768 SILVER SATIN ST","HENDERSON","NV","89044","1128a1","20250918","00000000","00000000",""
"VAIL","GARRETT","BRADLEY","","EMPLOYEE - PRIVATE S","PERSONAL CARE PROVID","","0000000000","19970508","2502 WARD STREET","VAN BUREN","AR","72956","1128a1","20250918","00000000","00000000",""
"VAIL","RONALD","ALFRED JR","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19730216","2507 DAVA STREET","VAN BUREN","AR","72956","1128a1","20250918","00000000","00000000",""
"VAN AUKEN","JESSICA","LAUREN","","IND- LIC HC SERV PRO","NURSE PRACTITIONER (","","1598134173","19861102","3350 GLADE CREEK BLVD NE, APT","ROANOKE","VA","24012","1128b4","20250918","00000000","00000000",""
"VAN DER BOS","LAURIE","LYNN","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19591129","5297 S 31ST STREET","KALAMAZOO","MI","49048","1128b4","20250918","00000000","00000000",""
"WADLEY","ANTHONY","JUAN II","","INDIVIDUAL (UNAFFILI","PERSONAL CARE PROVID","","0000000000","19901123","501 KELLY AVE, APT 3","PITTSBURGH","PA","15221","1128a1","20250918","00000000","00000000",""
"WILES","TOMMIE","ELAINE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19891229","560 OLD PRATER RD","MARION","VA","24354","1128b4","20250918","00000000","00000000",""
"WILLIAMS","CELESTE","DIANNE","","IND- LIC HC SERV PRO","NURSE/NURSES AIDE","","0000000000","19931001","22701 OLD RIVER RD","VANCLEAVE","MS","39565","1128b4","20250918","00000000","00000000",""
"YOUNG","EUGENE","JR","","EMPLOYEE-GOVERNMENT","MEDICARE PART D CONT","","0000000000","19610114","222 N MULLER ST, APT 90","ANAHEIM","CA","92801","1128a1","20250918","00000000","00000000",""