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General NPI Number Information
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NPI Number | 1346022878
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Entity Type | Organization
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Legal Business Name | BANYAN WELLNESS CENTER LLC
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Dates
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Enumeration Date | 10/18/2023
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 320 OHUKAI RD STE 414
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City | KIHEI
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State | HI
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Zip | 96753-7060
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Country | US
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Telephone | 808-666-1937
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Fax |
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Provider Business Mailing Address
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Address Line | 320 OHUKAI RD STE 414
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City | KIHEI
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State | HI
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Zip | 96753-7060
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Country | US
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Telephone | 808-666-1937
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TAYNA NICOLE MILLER
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Credential | PMHNP-BC
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Telephone | 808-633-7132
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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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