MEDICARE: MIND RENEWED PSYCHIATRY 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	:	1659115996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND RENEWED PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	712 H ST NE STE 8919
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3627
Country	:	US
Telephone Number	:	202-800-8919
Fax Number	:	771-717-8669

Provider Business Practice Location Address
First Line	:	9015 WOODYARD RD STE 202
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-4209
Country	:	US
Telephone Number	:	202-800-8919
Fax Number	:	771-717-8669

Authorized Official
Title or Position	:	NURSE PRACTITONER
Name	:	DAGUSE DONACIN
Credential	:	NP
Telephone Number	:	202-800-8919

Provider Enumeration Date	:	06/21/2024
Last Update Date	:	12/10/2025

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