Provider Demographics
NPI:1851000103
Name:GREEN WAVES PSYCHIATRY NURSING INC
Entity Type:Organization
Organization Name:GREEN WAVES PSYCHIATRY NURSING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DALKYE
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:858-727-9056
Mailing Address - Street 1:10531 4S COMMONS DR STE 166-445
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3517
Mailing Address - Country:US
Mailing Address - Phone:858-727-9056
Mailing Address - Fax:
Practice Address - Street 1:7220 TRADE ST STE 215
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2326
Practice Address - Country:US
Practice Address - Phone:858-727-9056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty