Provider Demographics
NPI:1043962079
Name:MINDFUL NATURE PRACTICE: A PROFESSIONAL NURSING CORPORATION
Entity Type:Organization
Organization Name:MINDFUL NATURE PRACTICE: A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PMHNP, CMT-P
Authorized Official - Phone:415-578-0343
Mailing Address - Street 1:147 ROSS ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4958
Mailing Address - Country:US
Mailing Address - Phone:415-578-0343
Mailing Address - Fax:
Practice Address - Street 1:147 ROSS ST APT 1
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4958
Practice Address - Country:US
Practice Address - Phone:415-578-0343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health