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General NPI Number Information
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NPI Number | 1679375810
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Entity Type | Organization
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Legal Business Name | MINDBODY OASIS LLC
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 5972 WELLINGTON PEAK RD
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City | LAS VEGAS
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State | NV
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Zip | 89148-1498
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Country | US
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Telephone | 702-812-0925
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Fax |
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Provider Business Mailing Address
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Address Line | 5972 WELLINGTON PEAK RD
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City | LAS VEGAS
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State | NV
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Zip | 89148-1498
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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 | APRN
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Name | MISS GRACE KORIR
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Credential | FNP-C, PMHNP-BC
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Telephone | 702-812-0925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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