Healthcare Provider Details
I. General information
NPI: 1194258376
Provider Name (Legal Business Name): A PEACE OF MIND
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1326 S GOVERNORS AVE STE C
DOVER DE
19904-4800
US
IV. Provider business mailing address
1326 S GOVERNORS AVE STE C
DOVER DE
19904-4800
US
V. Phone/Fax
- Phone: 302-674-3168
- Fax: 302-736-1280
- Phone: 302-674-3168
- Fax: 302-736-1280
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364SP0808X |
| Taxonomy | Psychiatric/Mental Health Clinical Nurse Specialist |
| License Number | 2017602789 |
| License Number State | DE |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 2017602789 |
| License Number State | DE |
VIII. Authorized Official
Name:
GWYNN
A
STUP
Title or Position: OWNER
Credential: APRN-CNP
Phone: 302-674-3168