Organization
PHOENIXMIDES LLC
Active
Other names
Phoenixmides Mental Health & Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
OLUWASEYI OLADIPUPO SOETAN PMHNP-BC (PSYCHIATRIC NURSE PRACTITIONER)
(540) 204-2459
Entity
Organization
Contact information
Practice address
591 OAKWOOD CIR, PETERSBURG, VA 23805-9339
(540) 204-2459
Mailing address
5706 GOSSAMER CT, MOSELEY, VA 23120-2339
(154) 020-4245
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/18/2023
Last updated
02/12/2024
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