Provider Demographics
NPI:1205695806
Name:TAKECARE INTEGRATIVE PSYCHIATRY & WELLNESS
Entity type:Organization
Organization Name:TAKECARE INTEGRATIVE PSYCHIATRY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:PRINCESS
Authorized Official - Middle Name:DASHAE
Authorized Official - Last Name:EGHIANRUWA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:972-750-1617
Mailing Address - Street 1:110 IH 35 N
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5003
Mailing Address - Country:US
Mailing Address - Phone:512-537-3856
Mailing Address - Fax:
Practice Address - Street 1:808 FORTROSE TER
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-6042
Practice Address - Country:US
Practice Address - Phone:972-750-1617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty