Provider Demographics
NPI:1730659723
Name:JEREMY R VERHINES NURSING CORPORATION
Entity Type:Organization
Organization Name:JEREMY R VERHINES NURSING CORPORATION
Other - Org Name:PURPOSE PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:VERHINES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:949-750-7082
Mailing Address - Street 1:32565 GOLDEN LANTERN ST # B479
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3261
Mailing Address - Country:US
Mailing Address - Phone:949-750-7082
Mailing Address - Fax:252-250-2029
Practice Address - Street 1:3404 VIA LIDO STE 2B
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3991
Practice Address - Country:US
Practice Address - Phone:949-750-7082
Practice Address - Fax:252-250-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty