Provider Demographics
NPI:1891685376
Name:MINDFUL BALANCE INTEGRATED WEIGHT LOSS AND WELLNESS
Entity type:Organization
Organization Name:MINDFUL BALANCE INTEGRATED WEIGHT LOSS AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOE-DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-287-1999
Mailing Address - Street 1:6032 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7018
Mailing Address - Country:US
Mailing Address - Phone:262-900-8186
Mailing Address - Fax:262-287-0884
Practice Address - Street 1:6032 40TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7018
Practice Address - Country:US
Practice Address - Phone:262-900-8186
Practice Address - Fax:262-287-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty