| Organization Name: | SOUTHERN OREGON AESTHETICS AND WELLNESS, LLC |
| NPI Number: | 1174920789 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MONIQUE A NOYES (OWNER) |
| Mailing Address: | 5005 Tolo Rd Central Point |
| State: | OR US |
| Postal Code: | 975029335 |
| Phone Number: | 7607310313 |
| Fax Number: | 7607310414 |
| NPI Enumeration Date: | 11/25/2014 |
| NPI Last Update Date: | 11/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 200850143NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |