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General NPI Number Information
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NPI Number | 1659115996
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Entity Type | Organization
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Legal Business Name | MIND RENEWED PSYCHIATRY LLC
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Dates
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Enumeration Date | 06/21/2024
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 9015 WOODYARD RD STE 202
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City | CLINTON
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State | MD
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Zip | 20735-4209
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Country | US
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Telephone | 202-800-8919
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Fax | 771-717-8669
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Provider Business Mailing Address
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Address Line | 712 H ST NE STE 8919
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City | WASHINGTON
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State | DC
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Zip | 20002-3627
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Country | US
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Telephone | 202-800-8919
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Fax | 771-717-8669
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Authorized Official
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Title or Position | NURSE PRACTITONER
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Name | DAGUSE DONACIN
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Credential | NP
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Telephone | 202-800-8919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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