Provider Demographics
NPI:1902627284
Name:MOONSTONE INTEGRATIVE HEALTH A NURSING PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MOONSTONE INTEGRATIVE HEALTH A NURSING PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PMHNP
Authorized Official - Phone:707-243-3348
Mailing Address - Street 1:26 LAS PALOMAS
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-1916
Mailing Address - Country:US
Mailing Address - Phone:707-243-3348
Mailing Address - Fax:
Practice Address - Street 1:11154 JAMES WAY DR SE
Practice Address - Street 2:
Practice Address - City:AUMSVILLE
Practice Address - State:OR
Practice Address - Zip Code:97325-9479
Practice Address - Country:US
Practice Address - Phone:707-243-3348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty