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General NPI Number Information
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NPI Number | 1316116684
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Entity Type | Individual
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Provider Name | NINA O'MAILIA PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 21900 WILLAMETTE DR STE 209
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City | WEST LINN
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State | OR
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Zip | 97068-3284
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Country | US
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Telephone | 971-274-0038
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Fax | 971-202-2099
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Provider Business Mailing Address
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Address Line | 11507 SE FLAVEL ST
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City | PORTLAND
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State | OR
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Zip | 97266-5985
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Country | US
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Telephone | 503-915-2090
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA152466
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License Number State | OR
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