THE CHANGING TIDE BODY MIND & SPIRIT PC DBA I CHOOSE LIFE INC. NPI 1962196683

NPI Information

NPI: 1962196683
Provider Name: THE CHANGING TIDE BODY MIND & SPIRIT PC DBA I CHOOSE LIFE INC.

Doing Business As: I CHOOSE LIFE INC.

Classification: Nurse Practitioner - 363LP0808X
Entity Type: Organization

Specialization: Psychiatric/Mental Health

Address:
75 MAIN STREET
STE E
MATHEWS, VA
ZIP 23109
Phone: (804) 725-3041
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THE CHANGING TIDE BODY MIND & SPIRIT PC DBA I CHOOSE LIFE INC. is a psychiatric/mental health nurse practitioner in Mathews, VA. THE CHANGING TIDE BODY MIND & SPIRIT PC DBA I CHOOSE LIFE INC. NPI is 1962196683. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As I Choose Life Inc..

The provider's business location address is:

75 MAIN STREET
STE E
MATHEWS, VA
ZIP 23109
Phone: (804) 725-3041
Fax: (804) 725-3510

The provider's authorized official is Debra Moore Zierow .
The authorized official title is Owner and has the following contact phone number (804) 725-3041.

The enumeration date for this NPI number is 6/6/2023 and was last updated on 6/20/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2019115759	MEDICAID	VIRGINIA
2	VVU978C639	OTHER	VIRGINIA	MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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