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General NPI Number Information
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NPI Number | 1992402317
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Entity Type | Organization
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Legal Business Name | MEDICAL INTERVENTIONS FOR NEUROPLASTIC DEVELOPMENT HUB. LLC
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 7766 SW BAYBERRY DR
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City | BEAVERTON
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State | OR
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Zip | 97007-5551
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Country | US
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Telephone | 971-357-2275
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Fax | 971-369-7509
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Provider Business Mailing Address
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Address Line | 7766 SW BAYBERRY DR
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City | BEAVERTON
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State | OR
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Zip | 97007-5551
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Country | US
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Telephone | 971-727-9921
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MS. ESTHER GABRIELLE ROSENGARTEN
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Credential | PMHNP-BC
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Telephone | 971-727-9921
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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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