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Individual

CHARLES H FAUTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RN

Contact information

Practice address
530 NW 27TH ST, CORVALLIS, OR 97330-5223
(541) 766-6835
(541) 766-6186
Mailing address
PO BOX 579, CORVALLIS, OR 97339-0579
(541) 766-6835
(541) 766-6186

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
13288
REGISTERED NURSE
WY
01
19445
REGISTERED NURSE
AK
Enumeration date
12/12/2006
Last updated
07/08/2007
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