Healthcare Provider Details

I. General information

NPI: 1992469613
Provider Name (Legal Business Name): HERB N OASIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 10/28/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MELBOURNE ST
DORCHESTER CENTER MA
02124-2422
US

IV. Provider business mailing address

2529 W CACTUS RD APT 2136
PHOENIX AZ
85029-2596
US

V. Phone/Fax

Practice location:
  • Phone: 617-650-5412
  • Fax:
Mailing address:
  • Phone: 617-650-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: AMANDA JANAE BRIGGS
Title or Position: DIRECTOR OF HOLISTIC WELLNESS
Credential:
Phone: 617-650-5412