Healthcare Provider Details

I. General information

NPI: 1780524488
Provider Name (Legal Business Name): MINDWELL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 CONCORD PIKE STE 301
WILMINGTON DE
19803-3644
US

IV. Provider business mailing address

1521 CONCORD PIKE STE 301
WILMINGTON DE
19803-3644
US

V. Phone/Fax

Practice location:
  • Phone: 267-972-6688
  • Fax:
Mailing address:
  • Phone: 267-972-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. OLIVIA MARIE MOURAS
Title or Position: CEO OWNER
Credential: NP
Phone: 267-972-6688