Provider Demographics
NPI:1982326740
Name:MENTAL WELLNESS FOR LIFE A NURSING CORPORATION
Entity Type:Organization
Organization Name:MENTAL WELLNESS FOR LIFE A NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCH NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:ZOMMICK
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:818-688-6826
Mailing Address - Street 1:28212 KELLY JOHNSON PKWY STE 215
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5090
Mailing Address - Country:US
Mailing Address - Phone:818-688-6826
Mailing Address - Fax:
Practice Address - Street 1:28212 KELLY JOHNSON PKWY STE 215
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5090
Practice Address - Country:US
Practice Address - Phone:818-688-6826
Practice Address - Fax:877-349-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty