Provider Demographics
NPI:1992402317
Name:MEDICAL INTERVENTIONS FOR NEUROPLASTIC DEVELOPMENT HUB. LLC
Entity type:Organization
Organization Name:MEDICAL INTERVENTIONS FOR NEUROPLASTIC DEVELOPMENT HUB. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:GABRIELLE
Authorized Official - Last Name:ROSENGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:971-727-9921
Mailing Address - Street 1:7766 SW BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-5551
Mailing Address - Country:US
Mailing Address - Phone:971-727-9921
Mailing Address - Fax:
Practice Address - Street 1:7766 SW BAYBERRY DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-5551
Practice Address - Country:US
Practice Address - Phone:971-357-2275
Practice Address - Fax:971-369-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty