Provider Demographics
NPI:1760290787
Name:MINDWAVE MEDICINE LLC
Entity type:Organization
Organization Name:MINDWAVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:RORER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, AGACNP-BC
Authorized Official - Phone:808-400-5805
Mailing Address - Street 1:100 KAHELU AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3913
Mailing Address - Country:US
Mailing Address - Phone:808-400-5805
Mailing Address - Fax:866-756-3916
Practice Address - Street 1:100 KAHELU AVE STE 100
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3913
Practice Address - Country:US
Practice Address - Phone:808-400-5805
Practice Address - Fax:866-756-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)