Healthcare Provider Details

I. General information

NPI: 1043962079
Provider Name (Legal Business Name): MINDFUL NATURE PRACTICE: A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 ROSS ST APT 1
SAN RAFAEL CA
94901-4958
US

IV. Provider business mailing address

147 ROSS ST APT 1
SAN RAFAEL CA
94901-4958
US

V. Phone/Fax

Practice location:
  • Phone: 415-578-0343
  • Fax:
Mailing address:
  • Phone: 415-578-0343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. DENISE MICHELLE BELANGER
Title or Position: OWNER
Credential: PHD, PMHNP, CMT-P
Phone: 415-578-0343