Provider Demographics
NPI:1427840313
Name:LIFESPAN PSYCHIATRY AND WELLNESS LIMITED LIABILITY LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:LIFESPAN PSYCHIATRY AND WELLNESS LIMITED LIABILITY LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:FADUMO
Authorized Official - Middle Name:I
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-250-7034
Mailing Address - Street 1:3800 AMERICAN BLVD W STE 1500
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-4429
Mailing Address - Country:US
Mailing Address - Phone:206-250-7034
Mailing Address - Fax:
Practice Address - Street 1:3800 AMERICAN BLVD W STE 1500
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-4429
Practice Address - Country:US
Practice Address - Phone:206-250-7034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty