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General NPI Number Information
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NPI Number | 1265210058
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Entity Type | Organization
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Legal Business Name | BLUE LOTUS EMPOWERMENT NURSING CORPORATION
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Dates
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Enumeration Date | 09/21/2023
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 11209 BROCKWAY RD STE 303
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City | TRUCKEE
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State | CA
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Zip | 96161-2220
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Country | US
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Telephone | 530-802-0622
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4127
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City | TRUCKEE
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State | CA
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Zip | 96160-4127
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | MS. GRETCHEN HEMBERGER
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Credential | PMHNP-BC
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Telephone | 802-233-7830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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