# PHOENIXMIDES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Phoenixmides Mental Health & Wellness
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023896586
- **Authorized official:** OLUWASEYI OLADIPUPO SOETAN PMHNP-BC (PSYCHIATRIC NURSE PRACTITIONER)
- **Authorized official phone:** (540) 204-2459

## Contact information

- **Practice address:** 591 OAKWOOD CIR, PETERSBURG, VA 23805-9339
- **Practice address phone:** (540) 204-2459
- **Mailing address:** 5706 GOSSAMER CT, MOSELEY, VA 23120-2339
- **Mailing address phone:** (154) 020-4245

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/18/2023
- **Last updated:** 02/12/2024