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General NPI Number Information
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NPI Number | 1477972107
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Entity Type | Organization
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Legal Business Name | ROSE CABINET MEDICINE LLC
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 2135 NE 55TH AVE
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City | PORTLAND
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State | OR
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Zip | 97213-2622
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Country | US
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Telephone | 503-308-8608
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Fax | 503-406-2302
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Provider Business Mailing Address
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Address Line | 2135 NE 55TH AVE
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City | PORTLAND
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State | OR
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Zip | 97213-2622
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Country | US
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Telephone | 503-308-8608
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Fax | 503-406-2302
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER LOUISE ROSE
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Credential | ND
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Telephone | 503-308-8608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 1816
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License Number State | OR
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