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Nursing Assistant Expired Certification Activation Application

Certified Activation Application F Male F Female F Prefer Not to Answer F X Social Security Number National Provider Identifier Number (SSN) (If you do not have a SSN, see instructions) (NPI) (Enter 10 digit number) Nursing Assistant Certified Credentialing P.O. Box 1099 Olympia, WA 98507-1099

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  Applications, Instructions, Provider, Credentialing

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