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STI Quality Reporting Registry Deactivation (2025)
Provider #1
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First
Last
Credentials
Provider #1 NPI
*
Provider #1 Email
*
Would you like to deactivate another provider?
Yes
No
Provider #2
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Last
Credentials
Provider #2 NPI
Provider #2 Email
Would you like to deactivate another provider?
Yes
No
Provider #3
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Last
Credentials
Provider #3 NPI
Provider #3 Email
Would you like to deactivate another provider?
Yes
No
Provider #4
First
Last
Credentials
Provider #4 NPI
Provider #4 Email
Would you like to deactivate another provider?
Yes
No
Provider #5
First
Last
Credentials
Provider #5 NPI
Provider #5 Email
Would you like to deactivate another provider?
Yes
No
Provider #6
First
Last
Credentials
Provider #6 NPI
Provider #6 Email
Would you like to deactivate another provider?
Yes
No
Provider #7
First
Last
Credentials
Provider #7 NPI
Provider #7 Email
Would you like to deactivate another provider?
Yes
No
Provider #8
First
Last
Credentials
Provider #8 NPI
Provider #8 Email
Would you like to deactivate another provider?
Yes
No
Provider #9
First
Last
Credentials
Provider #9 NPI
Provider #9 Email
Would you like to deactivate another provider?
Yes
No
Provider #10
First
Last
Credentials
Provider #10 NPI
Provider #10 Email
Practice Name
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Address
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Contact Name
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