NPIMap

Organization Active NPI

Southern Oregon Aesthetics and Wellness, LLC

  • Family Nurse Practitioner
  • Central Point, OR
National Provider Identifier
1174920789
Registry record updated Nov 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
200850143NP Issued in OR
Legal business name
SOUTHERN OREGON AESTHETICS AND WELLNESS, LLC
Practice address
5005 Tolo Rd
Central Point, OR 97502-9335
Phone
(760) 731-0313
Fax
(760) 731-0414
NPI assigned
Nov 25, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Monique A Noyes, F-NP/RNFANPI 1336394089
Title
Owner
Phone
(541) 840-8487

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 200850143NP OR Primary

Addresses

Primary practice location

5005 Tolo Rd
Central Point, OR 97502-9335

Mailing address

5005 Tolo Rd
Central Point, OR 97502-9335
Phone (760) 731-0313

Other identifiers 1

IdentifierTypeStateIssuer
098000578RNOtherORRN FIRST ASSISTANT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416960000000",
    "number": "1174920789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5005 TOLO RD",
            "city": "CENTRAL POINT",
            "state": "OR",
            "postal_code": "975029335",
            "telephone_number": "760-731-0313",
            "fax_number": "760-731-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5005 TOLO RD",
            "city": "CENTRAL POINT",
            "state": "OR",
            "postal_code": "975029335",
            "telephone_number": "760-731-0313",
            "fax_number": "760-731-0414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OREGON AESTHETICS AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-25",
        "last_updated": "2014-11-26",
        "status": "A",
        "authorized_official_last_name": "NOYES",
        "authorized_official_first_name": "MONIQUE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-840-8487",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "F-NP/RNFA"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "200850143NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN FIRST ASSISTANT",
            "identifier": "098000578RN",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Central Point, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.