MEDICARE: MINDBODY OASIS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1699658864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDBODY OASIS LLC

Provider Business Mailing Address
First Line	:	5972 WELLINGTON PEAK RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1498
Country	:	US
Telephone Number	:	702-812-0925
Fax Number	:

Provider Business Practice Location Address
First Line	:	5972 WELLINGTON PEAK RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1498
Country	:	US
Telephone Number	:	702-812-0925
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GRACE KORIR
Credential	:	APRN
Telephone Number	:	702-812-0925

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	07/28/2025

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