Provider Demographics
NPI:1346001104
Name:HEART AND MIND WELLNESS NURSING CORPORATION
Entity Type:Organization
Organization Name:HEART AND MIND WELLNESS NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:424-728-5564
Mailing Address - Street 1:2615 PACIFIC COAST HWY STE 204
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2227
Mailing Address - Country:US
Mailing Address - Phone:424-728-5564
Mailing Address - Fax:424-377-6548
Practice Address - Street 1:1000 N SEPULVEDA BLVD STE 280
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5975
Practice Address - Country:US
Practice Address - Phone:424-728-5564
Practice Address - Fax:424-377-6548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty