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General NPI Number Information
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NPI Number | 1285964304
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Entity Type | Organization
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Legal Business Name | VIRTUAL NURSE PRACTITIONER LLC
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 2654 NE JILL CT
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City | BEND
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State | OR
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Zip | 97701-5887
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Country | US
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Telephone | 541-419-6337
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Fax | 866-638-8660
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Provider Business Mailing Address
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Address Line | 2654 NE JILL CT
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City | BEND
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State | OR
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Zip | 97701-5887
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Country | US
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Telephone | 541-419-6337
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Fax | 866-638-8660
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MR. JEFFREY M GONZALES
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Credential | FNP-C
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Telephone | 541-419-6337
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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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