Provider Demographics
NPI:1801614003
Name:ASTRAVANT PSYCHIATRY NURSING PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ASTRAVANT PSYCHIATRY NURSING PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAERLAN-FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-438-2288
Mailing Address - Street 1:112 E AMERIGE AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1920
Mailing Address - Country:US
Mailing Address - Phone:949-438-2288
Mailing Address - Fax:
Practice Address - Street 1:112 E AMERIGE AVE STE 308
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1920
Practice Address - Country:US
Practice Address - Phone:949-438-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty