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General NPI Number Information
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NPI Number | 1568959203
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Entity Type | Individual
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Provider Name | REBEKAH SHEA WIELAND MD
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Gender | Female
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 123 INTERNATIONAL WAY
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1047
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Country | US
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Telephone | 541-222-6914
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Fax | 541-326-0924
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Provider Business Mailing Address
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Address Line | PO BOX 72059
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City | SPRINGFIELD
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State | OR
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Zip | 97475-0285
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Country | US
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Telephone | 541-222-6915
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Fax | 541-326-0924
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | MD220278
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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