Provider Demographics
NPI:1699658864
Name:MINDBODY OASIS LLC
Entity type:Organization
Organization Name:MINDBODY OASIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:KORIR
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-812-0925
Mailing Address - Street 1:5972 WELLINGTON PEAK RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1498
Mailing Address - Country:US
Mailing Address - Phone:702-812-0925
Mailing Address - Fax:
Practice Address - Street 1:5972 WELLINGTON PEAK RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1498
Practice Address - Country:US
Practice Address - Phone:702-812-0925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty