NP Support & Alignment Network (NP SAN)

Please complete the following questions to join the NP SAN, and to be referred to a Practice Transformation Network (PTN). The information collected on this survey will be reported to the Centers for Medicare and Medicaid Services (CMS) and PTNs.

First Name

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* First Name

Last Name

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* Last Name

Practice Type

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* Practice Type

Practice Name

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* Practice Name

Practice Address

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* Practice Address

Phone Number

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* Phone Number

Email

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* Email

Email Confirmation

Question Title

* Email Confirmation

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33% of survey complete.

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