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General NPI Number Information
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NPI Number | 1902345234
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Entity Type | Organization
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Legal Business Name | STACIE WOLFE ND
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 7997 SW ALDEN ST
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City | PORTLAND
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State | OR
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Zip | 97223-9322
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Country | US
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Telephone | 503-318-1030
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Fax |
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Provider Business Mailing Address
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Address Line | 7997 SW ALDEN ST
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City | PORTLAND
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State | OR
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Zip | 97223-9322
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Country | US
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Telephone | 503-318-1030
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. STACIE RENE WOLFE
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Credential | ND
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Telephone | 503-318-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 4023
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License Number State | OR
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