Healthcare Provider Details

I. General information

NPI: 1972439248
Provider Name (Legal Business Name): ECDYSIS - A NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E COLORADO BLVD FL 5
PASADENA CA
91106-2327
US

IV. Provider business mailing address

1055 E COLORADO BLVD FL 5
PASADENA CA
91106-2327
US

V. Phone/Fax

Practice location:
  • Phone: 323-207-0765
  • Fax:
Mailing address:
  • Phone: 323-207-0765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN NAKANO
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 323-207-0765