Provider Demographics
NPI:1528830114
Name:HOLISTIC WELL NURSING CORP
Entity type:Organization
Organization Name:HOLISTIC WELL NURSING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CECILY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:781-384-1327
Mailing Address - Street 1:5297 COLLEGE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1798
Mailing Address - Country:US
Mailing Address - Phone:781-384-1327
Mailing Address - Fax:781-205-1564
Practice Address - Street 1:9585 SW WASHINGTON SQUARE RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-4450
Practice Address - Country:US
Practice Address - Phone:781-384-1327
Practice Address - Fax:781-205-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty