MEDICARE: MINDS-N-MOTION WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1053170886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDS-N-MOTION WELLNESS LLC

Provider Business Mailing Address
First Line	:	507 WILCOX RD APT A
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44515-6229
Country	:	US
Telephone Number	:	740-317-3237
Fax Number	:	330-953-2300

Provider Business Practice Location Address
First Line	:	10927 MAHONING AVE
Second Line	:
City	:	NORTH JACKSON
State	:	OH
Zip	:	44451-8705
Country	:	US
Telephone Number	:	844-408-3998
Fax Number	:	330-953-2300

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MRS. MELISSA NOVITS
Credential	:	APRN, FNP-C,PMHNP-C
Telephone Number	:	844-408-3998

Provider Enumeration Date	:	03/14/2024
Last Update Date	:	03/14/2024

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