Provider Demographics
NPI:1659152049
Name:ETERNITY MENTAL HEALTH NURSING CORP.
Entity Type:Organization
Organization Name:ETERNITY MENTAL HEALTH NURSING CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP, FNP
Authorized Official - Prefix:MS
Authorized Official - First Name:JASWINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BARN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, FNP
Authorized Official - Phone:209-819-4878
Mailing Address - Street 1:3144 G ST STE 125 PMB 258
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-1385
Mailing Address - Country:US
Mailing Address - Phone:209-819-4878
Mailing Address - Fax:
Practice Address - Street 1:3150 G ST STE E
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-1346
Practice Address - Country:US
Practice Address - Phone:209-875-2831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306331699Medicaid