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General NPI Number Information
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NPI Number | 1912762949
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Entity Type | Individual
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Provider Name | JERUSHA ANN JEROME RN
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Gender | Female
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 500 NE MULTNOMAH ST FL 7
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City | PORTLAND
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State | OR
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Zip | 97232-2023
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Country | US
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Telephone | 503-261-2090
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Fax | 503-261-2040
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Provider Business Mailing Address
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Address Line | 5335 SE 13TH CT
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City | GRESHAM
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State | OR
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Zip | 97080-2906
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Country | US
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Telephone | 503-334-7531
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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 | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | 200241525RN
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License Number State | OR
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