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General NPI Number Information
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NPI Number | 1710049176
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Entity Type | Individual
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Provider Name | BONNEY LOUISE ELLESTAD M.ED.
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Gender | Female
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 650 CLARK WAY
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City | PALO ALTO
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State | CA
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Zip | 94304-2300
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Country | US
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Telephone | 925-323-5536
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Fax |
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Provider Business Mailing Address
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Address Line | 530 SHOWERS DR # 7-104
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-4740
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Country | US
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Telephone | 925-323-5536
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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