Healthcare Provider Details

I. General information

NPI: 1164025185
Provider Name (Legal Business Name): URBAN OASIS WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 NE 4TH AVE STE 105
CAMAS WA
98607-2158
US

IV. Provider business mailing address

5706 NW EL REY DR
CAMAS WA
98607-9120
US

V. Phone/Fax

Practice location:
  • Phone: 312-203-7781
  • Fax:
Mailing address:
  • Phone: 312-203-7781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DENICE VALENT-MUSLEH
Title or Position: OWNER
Credential: FNP
Phone: 312-203-7781