Healthcare Provider Details

I. General information

NPI: 1619377322
Provider Name (Legal Business Name): ANTONIA PEREZ NP-PP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANTONIA ORTEGA-PEREZ NP-PP

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 WAITE STREET STE 1
NORTH BEND OR
97459
US

IV. Provider business mailing address

1890 WAITE STREET STE 1
NORTH BEND OR
97459
US

V. Phone/Fax

Practice location:
  • Phone: 541-756-6232
  • Fax: 541-756-6234
Mailing address:
  • Phone: 541-756-6232
  • Fax: 541-756-6234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP129913
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC001437
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1015425
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202113062NP-PP
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202113062NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: