Provider Demographics
NPI:1407433535
Name:MINDFUL WELLNESS AND NUTRITION LLC.
Entity Type:Organization
Organization Name:MINDFUL WELLNESS AND NUTRITION LLC.
Other - Org Name:MY MINDFUL NUTRITIONIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:CN
Authorized Official - Phone:480-675-4568
Mailing Address - Street 1:PO BOX 5930
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-5930
Mailing Address - Country:US
Mailing Address - Phone:480-675-4568
Mailing Address - Fax:480-907-1963
Practice Address - Street 1:8452 E SAN BERNARDO DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2441
Practice Address - Country:US
Practice Address - Phone:480-675-4568
Practice Address - Fax:480-907-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service