Provider Demographics
NPI:1659115996
Name:MIND RENEWED PSYCHIATRY LLC
Entity type:Organization
Organization Name:MIND RENEWED PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITONER
Authorized Official - Prefix:
Authorized Official - First Name:DAGUSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DONACIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:754-246-9552
Mailing Address - Street 1:550 MORSE ST NE APT 531
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7198
Mailing Address - Country:US
Mailing Address - Phone:754-246-9552
Mailing Address - Fax:
Practice Address - Street 1:9015 WOODYARD RD STE 202
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4209
Practice Address - Country:US
Practice Address - Phone:202-800-8919
Practice Address - Fax:771-717-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty