Healthcare Provider Details

I. General information

NPI: 1013864651
Provider Name (Legal Business Name): NEW VISION WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9860 SW HALL BLVD STE C4
PORTLAND OR
97223-8896
US

IV. Provider business mailing address

9860 SW HALL BLVD STE C4
PORTLAND OR
97223-8896
US

V. Phone/Fax

Practice location:
  • Phone: 971-431-2590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HONORINE NJITA
Title or Position: OWNER
Credential: DNP, FNP-BC
Phone: 313-529-1267