Provider Demographics
NPI:1336394089
Name:NOYES, MONIQUE ANNTOINETTE (FNP NP-PP)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:ANNTOINETTE
Last Name:NOYES
Suffix:
Gender:F
Credentials:FNP NP-PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3524 HEATHROW WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4004
Mailing Address - Country:US
Mailing Address - Phone:541-646-3505
Mailing Address - Fax:541-646-3553
Practice Address - Street 1:3524 HEATHROW WAY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-646-3505
Practice Address - Fax:541-646-3553
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200850143NP363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500605143Medicaid