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General NPI Number Information
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NPI Number | 1790963874
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH CARE DBA MT. CARMEL HOSPITAL
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 01/31/2008
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Provider Practice Location Address
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Address Line | 982 E COLUMBIA AVE
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City | COLVILLE
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State | WA
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Zip | 99114-3316
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Country | US
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Telephone | 509-685-2509
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Fax |
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Provider Business Mailing Address
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Address Line | 910 N WASHINGTON ST SUITE 209
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City | SPOKANE
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State | WA
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Zip | 99201-2202
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Country | US
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Telephone | 509-484-8069
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | DEBBIE L WICKLUND
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Credential |
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Telephone | 509-232-1173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | H-030
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License Number State | WA
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