Provider Demographics
NPI:1548591258
Name:MOYA, MONIQUE M (NP-PP)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:M
Last Name:MOYA
Suffix:
Gender:F
Credentials:NP-PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47815 HIGHWAY 58
Mailing Address - Street 2:
Mailing Address - City:OAKRIDGE
Mailing Address - State:OR
Mailing Address - Zip Code:97463-9572
Mailing Address - Country:US
Mailing Address - Phone:541-782-8304
Mailing Address - Fax:541-782-5823
Practice Address - Street 1:47815 HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:OAKRIDGE
Practice Address - State:OR
Practice Address - Zip Code:97463-9572
Practice Address - Country:US
Practice Address - Phone:541-782-8304
Practice Address - Fax:541-782-5823
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202110589NP-PP363LF0000X, 363LF0000X
FLRN9471287163WM0102X
174H00000X, 374J00000X
FLMW238176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No174H00000XOther Service ProvidersHealth Educator
No176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202110589NP-PPOtherNURSE PRACTITIONER LICENSE
FL021234300Medicaid
MTNUR-RN-LIC-127517OtherBOARD OF NURSING
FLRN9471287OtherBOARD OF NURSING