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Get IA Universal Practitioner Credentialing Application 2013-2024

_________________________________________ Last Name First Name Middle Name Title Type or print responses in ink. Complete this form in its entirety and attach all requested documentation and explanations. A CV or “See CV” may not be used in lieu of completing any answers on this application. If a question does not apply to you, answer with “Non-Applicable” or “N/A”. If additional space is necessary to provide answers, attach additional sheet(s) of paper. All dates must be formatted .

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The tips below will help you complete IA Universal Practitioner Credentialing Application easily and quickly:

  1. Open the document in the full-fledged online editing tool by clicking Get form.
  2. Fill in the requested fields that are yellow-colored.
  3. Hit the green arrow with the inscription Next to move from box to box.
  4. Use the e-autograph tool to e-sign the document.
  5. Put the date.
  6. Double-check the entire e-document to be sure that you have not skipped anything.
  7. Click Done and download your new document.

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