Provider Demographics
NPI:1225698889
Name:AGEWELL GERIATRICS, LLC
Entity Type:Organization
Organization Name:AGEWELL GERIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:LADENE
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-C, GNP-BC
Authorized Official - Phone:503-780-3708
Mailing Address - Street 1:13120 SW HEATHER CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5612
Mailing Address - Country:US
Mailing Address - Phone:503-780-3708
Mailing Address - Fax:503-639-3870
Practice Address - Street 1:13120 SW HEATHER CT
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-5612
Practice Address - Country:US
Practice Address - Phone:503-780-3708
Practice Address - Fax:503-639-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154613941OtherNPI
OR500698230Medicaid