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General NPI Number Information
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NPI Number | 1467114009
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Entity Type | Organization
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Legal Business Name | VALLEY INTEGRATIVE PSYCHIATRIC HEALTH & WELLNESS, NURSING CORPORATION
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 1822 W KETTLEMAN LN STE 1
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City | LODI
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State | CA
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Zip | 95242-4218
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Country | US
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Telephone | 209-689-0103
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Fax | 209-689-0131
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Provider Business Mailing Address
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Address Line | 4322 RIVERBANK CT
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City | STOCKTON
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State | CA
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Zip | 95219-2538
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Country | US
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Telephone | 209-662-0754
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Fax |
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Authorized Official
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Title or Position | CEO/ PMHNP
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Name | DR. ANISE WHEELER
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Credential | NURSE PRACTITIONER
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Telephone | 209-662-0754
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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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