AGEWELL GERIATRICS LLC NPI 1225698889

NPI Information

NPI: 1225698889
Provider Name: AGEWELL GERIATRICS, LLC
Classification: Nurse Practitioner - 363LP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
13120 SW HEATHER CT
BEAVERTON, OR
ZIP 97008
Phone: (503) 780-3708
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AGEWELL GERIATRICS, LLC is a primary care nurse practitioner in Beaverton, OR. AGEWELL GERIATRICS, LLC NPI is 1225698889. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

13120 SW HEATHER CT
BEAVERTON, OR
ZIP 97008-612
Phone: (503) 780-3708
Fax: (503) 639-3870

The provider's authorized official is Renee Ladene Reed .
The authorized official title is Owner/nurse Practitioner and has the following contact phone number (503) 780-3708.

The enumeration date for this NPI number is 6/17/2019 and was last updated on 6/17/2019.

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	363LP2300X	Nurse Practitioner	Primary Care			Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1154613941	OTHER		NPI
2	500698230	MEDICAID	OREGON

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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