Provider Demographics
NPI:1790400125
Name:ATOMIC MINDWORKS, LLC
Entity Type:Organization
Organization Name:ATOMIC MINDWORKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENA
Authorized Official - Middle Name:CHANTEL
Authorized Official - Last Name:APON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, PMHNP
Authorized Official - Phone:503-530-8521
Mailing Address - Street 1:12150 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2850
Mailing Address - Country:US
Mailing Address - Phone:503-530-8521
Mailing Address - Fax:
Practice Address - Street 1:12150 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2850
Practice Address - Country:US
Practice Address - Phone:503-530-8521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty