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General NPI Number Information
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NPI Number | 1366322265
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Entity Type | Organization
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Legal Business Name | PREMIER WELLNESS PROFESSIONAL NURSING CORPORATION
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 2648 INTERNATIONAL BLVD STE 115 PMB 1120
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City | OAKLAND
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State | CA
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Zip | 94601-1569
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Country | US
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Telephone | 510-761-7274
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Fax | 972-845-8004
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Provider Business Mailing Address
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Address Line | 2648 INTERNATIONAL BLVD STE
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City | OAKLAND
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State | CA
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Zip | 94601-1569
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Country | US
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Telephone | 510-761-7274
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOAN TAYLOR
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Credential | PMHNP-BC
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Telephone | 510-761-7274
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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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