Provider Demographics
NPI:1447023767
Name:MINDY'S MEDICINE
Entity type:Organization
Organization Name:MINDY'S MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGOON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:602-332-1519
Mailing Address - Street 1:9815 W KEYSER DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2914
Mailing Address - Country:US
Mailing Address - Phone:602-332-1519
Mailing Address - Fax:
Practice Address - Street 1:19420 N 59TH AVE STE A201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6892
Practice Address - Country:US
Practice Address - Phone:602-332-1519
Practice Address - Fax:623-321-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care