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General NPI Number Information
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NPI Number | 1912184557
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Entity Type | Individual
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Provider Name | TENIELLE RHAE HOLSTE PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 870 S FRONT ST STE 200
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City | CENTRAL POINT
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State | OR
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Zip | 97502-2779
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Country | US
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Telephone | 541-732-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3158
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City | PORTLAND
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State | OR
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Zip | 97208-3158
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Country | US
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Telephone | 415-732-8000
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1307
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.005749RX
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01324
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License Number State | OR
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