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General NPI Number Information
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NPI Number | 1306479597
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Entity Type | Organization
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Legal Business Name | BON VIVANT HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 02/17/2020
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 7000 SW HAMPTON ST STE 130
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City | PORTLAND
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State | OR
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Zip | 97223-8374
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Country | US
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Telephone | 971-258-1968
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Fax |
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Provider Business Mailing Address
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Address Line | 7522 SW ALOMA WAY APT 3
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City | PORTLAND
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State | OR
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Zip | 97223-7927
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Country | US
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Telephone | 704-904-8288
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | KAREN SPIEGELBERG DAVIS
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Credential | MS, CNS
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Telephone | 971-238-1968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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