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General NPI Number Information
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NPI Number | 1912485574
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Entity Type | Organization
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Legal Business Name | BRYCE WILLARDSON, LLC
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Dates
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Enumeration Date | 08/04/2018
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Last Update Date | 08/04/2018
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Provider Practice Location Address
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Address Line | 83960 SPRING HILL LN
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City | PLEASANT HILL
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State | OR
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Zip | 97455-9728
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Country | US
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Telephone | 801-824-4334
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Fax |
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Provider Business Mailing Address
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Address Line | 83960 SPRING HILL LN
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City | PLEASANT HILL
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State | OR
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Zip | 97455-9728
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Country | US
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Telephone | 801-824-4334
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE WILLARDSON
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Credential | FNP
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Telephone | 801-824-4334
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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 | 201404741
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License Number State | OR
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