Healthcare Provider Details

I. General information

NPI: 1407433535
Provider Name (Legal Business Name): MINDFUL WELLNESS AND NUTRITION LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8452 E SAN BERNARDO DR
SCOTTSDALE AZ
85258-2441
US

IV. Provider business mailing address

PO BOX 5930
SCOTTSDALE AZ
85261-5930
US

V. Phone/Fax

Practice location:
  • Phone: 480-675-4568
  • Fax: 480-907-1963
Mailing address:
  • Phone: 480-675-4568
  • Fax: 480-907-1963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. LISA R SCHMIDT
Title or Position: OWNER
Credential: CN
Phone: 480-675-4568