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General NPI Number Information
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NPI Number | 1194756114
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Entity Type | Organization
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Legal Business Name | DAPHNE MED LLC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 1630 SISKIYOU BLVD STE B
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City | ASHLAND
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State | OR
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Zip | 97520-2423
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Country | US
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Telephone | 541-664-5151
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Fax | 541-664-5155
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Provider Business Mailing Address
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Address Line | 1208 BEALL LN
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City | CENTRAL POINT
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State | OR
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Zip | 97502-1573
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Country | US
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Telephone | 541-664-5151
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Fax | 541-664-5155
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAROLYN F SELF
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Credential | FNP
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Telephone | 541-664-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State | OR
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