Healthcare Provider Details

I. General information

NPI: 1548591258
Provider Name (Legal Business Name): MONIQUE M MOYA NP-PP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47815 HIGHWAY 58
OAKRIDGE OR
97463-9572
US

IV. Provider business mailing address

47815 HIGHWAY 58
OAKRIDGE OR
97463-9572
US

V. Phone/Fax

Practice location:
  • Phone: 541-782-8304
  • Fax: 541-782-5823
Mailing address:
  • Phone: 541-782-8304
  • Fax: 541-782-5823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202110589NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: