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General NPI Number Information
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NPI Number | 1902627284
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Entity Type | Organization
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Legal Business Name | MOONSTONE INTEGRATIVE HEALTH A NURSING PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 11154 JAMES WAY DR SE
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City | AUMSVILLE
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State | OR
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Zip | 97325-9479
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Country | US
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Telephone | 707-243-3348
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Fax |
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Provider Business Mailing Address
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Address Line | 26 LAS PALOMAS
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City | ORINDA
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State | CA
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Zip | 94563-1916
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Country | US
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Telephone | 707-243-3348
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AARON M MILLER
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Credential | RN, PMHNP
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Telephone | 707-243-3348
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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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