Provider Demographics
NPI:1104074459
Name:WHOLISTIC HEALTH FOR WOMEN
Entity type:Organization
Organization Name:WHOLISTIC HEALTH FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:APNP, WHNP, LAC
Authorized Official - Phone:619-260-0810
Mailing Address - Street 1:909 CURRY RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8508
Mailing Address - Country:US
Mailing Address - Phone:619-260-0810
Mailing Address - Fax:
Practice Address - Street 1:909 CURRY ROAD
Practice Address - Street 2:
Practice Address - City:ROSENBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8508
Practice Address - Country:US
Practice Address - Phone:619-260-0810
Practice Address - Fax:541-802-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 261Q00000X
CARN456541NP5830163WN1003X, 363L00000X, 363LX0001X
CAAC5147171100000X
CAC51231208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No163WN1003XNursing Service ProvidersRegistered NurseNutrition SupportGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11881456OtherBLUE CROSS