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General NPI Number Information
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NPI Number | 1750899035
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Entity Type | Organization
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Legal Business Name | SANTIAM MOBILE MEDICINE LLC
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Dates
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Enumeration Date | 01/20/2018
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Last Update Date | 05/31/2025
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Provider Practice Location Address
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Address Line | 41805 STAYTON SCIO RD SE
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City | STAYTON
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State | OR
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Zip | 97383-9739
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Country | US
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Telephone | 503-507-5356
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Fax | 866-225-2708
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Provider Business Mailing Address
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Address Line | PO BOX 118
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City | STAYTON
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State | OR
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Zip | 97383-0118
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Country | US
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Telephone | 503-507-5356
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Fax | 866-225-1708
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Authorized Official
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Title or Position | MEMBER
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Name | CASEY LULAY
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Credential | MSN, FNP
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Telephone | 503-507-5356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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