Healthcare Provider Details

I. General information

NPI: 1093661068
Provider Name (Legal Business Name): THE NOIRE NURSE WELLNESS COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2957 PALOMINO CT
ONTARIO CA
91761-9181
US

IV. Provider business mailing address

2957 PALOMINO CT
ONTARIO CA
91761-9181
US

V. Phone/Fax

Practice location:
  • Phone: 909-293-8339
  • Fax:
Mailing address:
  • Phone: 424-477-8890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MS. GYNIEKA GISELLE HARVEY
Title or Position: MANAGING MEMBER
Credential: RN
Phone: 909-293-8339