Rose Waggoner, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

084058952N1 Issued in OR

Practice address

16770 SW Edy Rd
Sherwood, OR 97140-9678

Phone

(503) 216-9600

Fax

(503) 216-9650

NPI assigned

Oct 12, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1598854960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16770 SW EDY RD",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971409678",
            "telephone_number": "503-216-9600",
            "fax_number": "503-216-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "ROSE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "084058952N1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084504",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rwaggoner107729@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "5050 NE Hoyt St Ste B48",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972132946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Nurse Practitioner in Sherwood, OR
• Providers in Sherwood, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; 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.