Mind Body Nurse Practitioner Inc

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95000404 Issued in CA

Legal business name

MIND BODY NURSE PRACTITIONER INC

Practice address

1347 Huckleberry LN
San Jacinto, CA 92582-4219

Phone

(951) 966-7730

Fax

(417) 890-9127

NPI assigned

May 25, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michelle Brilee, FNP-BC

Title

President

Phone

(951) 966-7730

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432512000000",
    "number": "1386023265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1347 HUCKLEBERRY LN",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925824219",
            "telephone_number": "951-966-7730",
            "fax_number": "417-890-9127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1347 HUCKLEBERRY LN",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925824219",
            "telephone_number": "951-966-7730",
            "fax_number": "417-890-9127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY NURSE PRACTITIONER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-25",
        "last_updated": "2015-05-25",
        "status": "A",
        "authorized_official_last_name": "BRILEE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-966-7730",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95000404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Marie Miller, LCSW
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• Dyshanay Daima Milton
• Alfons N Mina
• Alexis Lia Minor
• Madison Margaret Miracle, LCSW
• Mirai Medical Massage Spa
• Diana Miranda
• Maina Miricho, NP

• Nurse Practitioner in San Jacinto, CA
• Providers in San Jacinto, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.