Provider Demographics
NPI:1902579774
Name:HOLISTIC MISFIT, LLC
Entity Type:Organization
Organization Name:HOLISTIC MISFIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEIDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-318-3995
Mailing Address - Street 1:1795 FRY RD STE 368
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-3347
Mailing Address - Country:US
Mailing Address - Phone:832-318-3995
Mailing Address - Fax:
Practice Address - Street 1:23223 FIRST PARK DR APT 7211
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2550
Practice Address - Country:US
Practice Address - Phone:832-318-3995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty