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General NPI Number Information
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NPI Number | 1366886293
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Entity Type | Individual
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Provider Name | ANGELA AMUNDSON FNP
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Gender | Female
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Dates
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Enumeration Date | 04/22/2013
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Last Update Date | 04/16/2019
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Provider Practice Location Address
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Address Line | 9775 SE SUNNYSIDE RD SUITE 200
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City | CLACKAMAS
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State | OR
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Zip | 97015-5739
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Country | US
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Telephone | 503-655-8471
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Fax | 503-723-4907
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Provider Business Mailing Address
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Address Line | 619 NW 6TH AVE
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City | PORTLAND
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State | OR
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Zip | 97209-3964
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Country | US
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Telephone | 503-988-7468
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Fax | 503-988-3015
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 201142795RN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201508262NP-PP
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License Number State | OR
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