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General NPI Number Information
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NPI Number | 1033853783
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Entity Type | Organization
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Legal Business Name | NORTHWEST VITALITY GROUP
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 9233 SW 52ND AVE
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City | PORTLAND
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State | OR
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Zip | 97219-5003
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Country | US
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Telephone | 503-757-8535
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Fax | 971-223-0949
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Provider Business Mailing Address
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Address Line | 3 MONROW PKWY STE P #714
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City | LAKE OSWEGO
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State | OR
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Zip | 97035
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Country | US
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Telephone | 503-477-5084
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER/CMO
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Name | DR. HOLLY ANNE FAY
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Credential | DNP, APRN, FNP-A
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Telephone | 503-757-8535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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