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General NPI Number Information
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NPI Number | 1629021852
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Entity Type | Individual
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Provider Name | LYNDA BRADY STAFFORD DO
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Gender | Female
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 319 E PIONEER AVE
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City | MONTESANO
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State | WA
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Zip | 98563-4601
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Country | US
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Telephone | 360-249-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 HARRISON AVE NW STE 101
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City | OLYMPIA
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State | WA
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Zip | 98502-5084
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Country | US
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Telephone | 360-704-2362
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Fax | 360-350-1445
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OP00002036
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License Number State | WA
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