Provider Demographics
NPI:1467114009
Name:VALLEY INTEGRATIVE PSYCHIATRIC HEALTH & WELLNESS, NURSING CORPORATION
Entity Type:Organization
Organization Name:VALLEY INTEGRATIVE PSYCHIATRIC HEALTH & WELLNESS, NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PMHNP
Authorized Official - Prefix:DR
Authorized Official - First Name:ANISE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:209-662-0754
Mailing Address - Street 1:4322 RIVERBANK CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2538
Mailing Address - Country:US
Mailing Address - Phone:209-662-0754
Mailing Address - Fax:
Practice Address - Street 1:1822 W KETTLEMAN LN STE 1
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4218
Practice Address - Country:US
Practice Address - Phone:209-689-0103
Practice Address - Fax:209-689-0131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIP HEALTH & WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty