Provider Demographics
NPI:1972330827
Name:MINDFUL MEDICINE, LLC
Entity type:Organization
Organization Name:MINDFUL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAY
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:414-416-6398
Mailing Address - Street 1:1500 W MARKET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5083
Mailing Address - Country:US
Mailing Address - Phone:262-241-5955
Mailing Address - Fax:262-241-5926
Practice Address - Street 1:1500 W MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5083
Practice Address - Country:US
Practice Address - Phone:262-241-5955
Practice Address - Fax:262-241-5926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)