Provider Demographics
NPI:1912722554
Name:MINDFUL MEDICINE 360
Entity type:Organization
Organization Name:MINDFUL MEDICINE 360
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NP
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, PMHNP-BC
Authorized Official - Phone:319-693-1569
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-0015
Mailing Address - Country:US
Mailing Address - Phone:319-900-4525
Mailing Address - Fax:
Practice Address - Street 1:4403 1ST AVE SE STE 220
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3221
Practice Address - Country:US
Practice Address - Phone:319-900-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty