Healthcare Provider Details

I. General information

NPI: 1457281099
Provider Name (Legal Business Name): STILLWIND PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

4415 SONOMA HWY STE B
SANTA ROSA CA
95409-4165
US

IV. Provider business mailing address

4415 SONOMA HWY STE B
SANTA ROSA CA
95409-4165
US

V. Phone/Fax

Practice location:
  • Phone: 707-479-0618
  • Fax:
Mailing address:
  • Phone: 707-479-0618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN DAVID WILDGUST
Title or Position: DIRECTOR
Credential: PMHNP-C
Phone: 707-479-0618