# MIND BODY NOURISH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740090026
- **Authorized official:** MRS. ANISA ORTIZ CRNP (OWNER)
- **Authorized official phone:** (305) 930-2967

## Contact information

- **Practice address:** 2625 W GIRARD AVE, PHILADELPHIA, PA 19130-1333
- **Practice address phone:** (305) 930-2967
- **Mailing address:** 2901 MEREDITH PL, BENSALEM, PA 19020-2258
- **Mailing address phone:** (267) 455-9230

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/09/2025
- **Last updated:** 01/09/2025