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General NPI Number Information
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NPI Number | 1104957307
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Entity Type | Individual
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Provider Name | CAROL A SEVERSON LDM,CPM
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Gender | Female
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1209 SHORTRIDGE ST SE
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City | ALBANY
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State | OR
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Zip | 97322-6934
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Country | US
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Telephone | 541-928-1002
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Fax | 541-327-2721
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Provider Business Mailing Address
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Address Line | 2532 SANTIAM HWY SE PMB 314
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City | ALBANY
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State | OR
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Zip | 97322-5211
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Country | US
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Telephone | 541-928-1002
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Fax | 541-327-2721
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | DEM-LD102953
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License Number State | OR
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