Provider Demographics
NPI:1568284008
Name:MINDFULVISION PSYCHIATRY LLC
Entity type:Organization
Organization Name:MINDFULVISION PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEMILOLUWA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ILESANMI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:540-698-4259
Mailing Address - Street 1:15 WHEELWRIGHT LN
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8833
Mailing Address - Country:US
Mailing Address - Phone:540-698-4259
Mailing Address - Fax:540-736-0264
Practice Address - Street 1:15 WHEELWRIGHT LN
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8833
Practice Address - Country:US
Practice Address - Phone:540-698-4259
Practice Address - Fax:540-736-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty