| NPI | 1023896586 |
|---|---|
| Doing Business As | PHOENIXMIDES MENTAL HEALTH & WELLNESS |
| Entity Type | Organization |
| Authorized Contact | OLUWASEYI OLADIPUPO SOETAN Psychiatric Nurse Practitioner 540-204-2459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2024-02-12 |