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General NPI Number Information
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NPI Number | 1316698764
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Entity Type | Organization
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Legal Business Name | ELITE MEDICAL SERVICES PNW LLC
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 1216 13TH ST
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City | HOOD RIVER
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State | OR
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Zip | 97031-1612
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Country | US
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Telephone | 541-357-7750
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Fax |
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Provider Business Mailing Address
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Address Line | 1216 13TH ST
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City | HOOD RIVER
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State | OR
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Zip | 97031-1612
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Country | US
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Telephone | 541-357-7750
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAYLA NIXON
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Credential | FNP-C
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Telephone | 626-423-4693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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