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ROGUE FUNCTIONAL WELLNESS LLC NPI 1336485846


NPI Information

NPI: 1336485846
Provider Name: ROGUE FUNCTIONAL WELLNESS LLC
Classification: Nurse Practitioner - 363L00000X
Entity Type: Organization
Address:
761 GOLF VIEW DR
STE C
MEDFORD, OR
ZIP 97504
Phone: (541) 326-4294
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ROGUE FUNCTIONAL WELLNESS LLC is a nurse practitioner in Medford, OR. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. ROGUE FUNCTIONAL WELLNESS LLC NPI is 1336485846. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

761 GOLF VIEW DR
STE C
MEDFORD, OR
ZIP 97504-655
Phone: (541) 326-4294
Fax: (866) 629-9347

The provider's authorized official is Jason Jex .
The authorized official title is Owner and has the following contact phone number (541) 326-4294.

The enumeration date for this NPI number is 1/2/2013 and was last updated on 9/27/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363L00000XNurse PractitionerYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1R168426MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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