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General NPI Number Information
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NPI Number | 1114627585
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Entity Type | Organization
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Legal Business Name | MINDFUL MEDICAL CONSULTING LLC
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 838 WALKER RD STE 21-2
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City | DOVER
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State | DE
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Zip | 19904-2751
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Country | US
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Telephone | 302-513-7033
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Fax |
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Provider Business Mailing Address
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Address Line | 11 KIAMENSI RD
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City | WILMINGTON
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State | DE
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Zip | 19804-2907
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID GAINES
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Credential | NURSE PRACTITIONER
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Telephone | 302-513-7033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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