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General NPI Number Information
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NPI Number | 1003602830
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Entity Type | Individual
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Provider Name | MONIQUE HANDLOSER LAC
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Gender | Female
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 107 SW 2ND ST
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City | CORVALLIS
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State | OR
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Zip | 97333-4715
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Country | US
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Telephone | 541-602-8172
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Fax |
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Provider Business Mailing Address
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Address Line | 468 29TH PL
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City | PHILOMATH
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State | OR
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Zip | 97370-9369
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Country | US
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Telephone | 541-609-0087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC223813
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License Number State | OR
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