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General NPI Number Information
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NPI Number | 1609154517
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Entity Type | Individual
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Provider Name | TRISHA J WILDER PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 61250 SE COOMBS PL
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City | BEND
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State | OR
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Zip | 97702-3704
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Country | US
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Telephone | 541-706-5930
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Fax | 541-706-5931
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Provider Business Mailing Address
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Address Line | 1236 NW BALTIMORE AVE
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City | BEND
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State | OR
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Zip | 97703-3125
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Country | US
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Telephone | 530-526-3218
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA21676
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License Number State | CA
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