CLINIC FOR DERMATOLOGY & WELLNESS LLC NPI 1467908863

NPI Information

NPI: 1467908863
Provider Name: CLINIC FOR DERMATOLOGY & WELLNESS LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 38D2124889

Address:
2924 SISKIYOU BLVD STE 200
MEDFORD, OR
ZIP 97504
Phone: (541) 200-2793
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CLINIC FOR DERMATOLOGY & WELLNESS LLC is a family nurse practitioner in Medford, OR. CLINIC FOR DERMATOLOGY & WELLNESS LLC NPI is 1467908863. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2924 SISKIYOU BLVD STE 200
MEDFORD, OR
ZIP 97504-462
Phone: (541) 200-2793

The provider's authorized official is Joseph John Atzenbeck .
The authorized official title is Chief Executive Officer and has the following contact phone number (541) 200-2777.

The CLIA number assigned to this NPI record is 38D2124889 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 8/26/2016 and was last updated on 6/19/2021.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363A00000X	Physician Assistant				No
2	363LF0000X	Nurse Practitioner	Family			Yes

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

NPI Synchronization or Removal

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