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General NPI Number Information
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NPI Number | 1871574640
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Entity Type | Individual
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Provider Name | CAROL ELIZABETH BLENNING MD
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Gender | Female
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 09/20/2017
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Provider Practice Location Address
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Address Line | 3930 SE DIVISION ST
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City | PORTLAND
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State | OR
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Zip | 97202-1643
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Country | US
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Telephone | 503-418-3900
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Fax | 503-418-3939
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Provider Business Mailing Address
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Address Line | 2055 NW SAVIER ST. SUITE 201
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City | PORTLAND
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State | OR
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Zip | 97209-1773
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Country | US
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Telephone | 503-494-8417
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Fax | 503-346-8021
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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 | MD19941
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License Number State | OR
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