Provider Demographics
NPI:1093436784
Name:ADVANCED PSYCHIATRIC WELLNESS, A NURSING CORPORATION
Entity Type:Organization
Organization Name:ADVANCED PSYCHIATRIC WELLNESS, A NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:858-761-8731
Mailing Address - Street 1:11160 RANCHO CARMEL DR # 1041
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4672
Mailing Address - Country:US
Mailing Address - Phone:858-504-2308
Mailing Address - Fax:858-366-4442
Practice Address - Street 1:14505 SCARBORO ST
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-5947
Practice Address - Country:US
Practice Address - Phone:858-761-8731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty