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General NPI Number Information
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NPI Number | 1619842648
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Entity Type | Individual
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Provider Name | JULES JOEL DWELLE
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Gender |
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Dates
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Enumeration Date | 10/08/2025
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 300 N GRAHAM ST, MEDICAL OFFICE BLDG 3 STE 420
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City | PORTLAND
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State | OR
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Zip | 97227
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Country | US
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Telephone | 503-276-6154
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Fax |
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Provider Business Mailing Address
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Address Line | 13636 SW PACKARD LN
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City | BEAVERTON
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State | OR
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Zip | 97008-6897
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Country | US
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Telephone | 503-442-6120
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 114500
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License Number State | OR
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