Healthcare Provider Details

I. General information

NPI: 1366322265
Provider Name (Legal Business Name): PREMIER WELLNESS PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2648 INTERNATIONAL BLVD STE 115 PMB 1120
OAKLAND CA
94601-1569
US

IV. Provider business mailing address

2648 INTERNATIONAL BLVD STE 301
OAKLAND CA
94601-1580
US

V. Phone/Fax

Practice location:
  • Phone: 510-761-7274
  • Fax: 972-845-8004
Mailing address:
  • Phone: 510-761-7274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOAN NICHOLE TAYLOR
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 510-795-2434