Healthcare Provider Details

I. General information

NPI: 1962173252
Provider Name (Legal Business Name): MIND-BODY CONNECTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 E BASELINE RD STE 122
MESA AZ
85204-7288
US

IV. Provider business mailing address

3048 E BASELINE RD STE 122
MESA AZ
85204-7288
US

V. Phone/Fax

Practice location:
  • Phone: 602-980-8703
  • Fax: 602-962-4108
Mailing address:
  • Phone: 602-980-8703
  • Fax: 602-962-4108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY IGWE
Title or Position: OWNER
Credential:
Phone: 602-980-8703